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Recovery- Oriented System of Care ,Motivational Approach , in Substance Use Disorders

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Recovery- Oriented System of Care ,Motivational Approach , in Substance Use Disorders

  1. 1. Dr. Ahmed Albehairy , M.D Psychiatry Consultant AFCPC, TAIF, HADA, KSA MOH, EGYPT Recovery- Oriented System of Care , Motivational Approach , in Substance Use Disorders
  2. 2. Presentation Outline  Treatment of addiction .  Recovery in addiction.  Recovery care: sets and tool.  Motivational approach in recovery. Referrences: Marshall Smith Chair, Bri7sh Columbia Recovery Council,2016 Gail D'Onofrio, MD, Richard Saitz, MD, MPH, Paul Seale, MD, elearning , ASAM.
  3. 3. RECOVERY VS. TREATMENT
  4. 4. Treatment  As it relates to Substance Use Disorders, treatment generally refers to a direct medical intervention in the disease process - the acute response - and can include: • Residential care . • Outpatient care . • Pharmacotherapy . • Other direct medical interventions.
  5. 5. Recovery  A process of sustained change action that addresses the biological, psychological, social and spiritual disturbances inherent in addiction.  Aims to improve the quality of life by seeking balance and healing in all aspects of health and wellness.  Addressing an individual’s consistent pursuit of - abstinence, - dealing with cravings, - deals with the chronic relapsing nature of the disease. - impairment in behavioral control, - recognizing problems in one’s behaviors and interpersonal relationships, - and dealing more effectively with emotional responses.
  6. 6. Recovery  Addiction treatment is not recovery.  Depending on the substance used, there are non-pharmacological, evidence-based effective therapeutic modalities for helping addicts.  It is important to match the treatment to the needs of the patient.  Treatment plans must be continually assessed and organic to meet the changing needs of the individual.  Post-discharge supports must be in place to ensure continued care.
  7. 7. Recovery  An individual’s recovery actions lead to - reversal of negative. - self defeating internal processes and behaviors, allowing healing of relationships with self and others. - The concepts of acceptance and surrender may be useful in this process. !!!!!!!! Recovery is not only for addicts
  8. 8. A First Step to Recovery Understand the importance and limitations of detox as a first step to recovery. Medical detoxification by itself does little to change long- term drug use.
  9. 9. 2nd, Continuing Care Following Inpatient Treatment Discharge – The Role of the Physician in Follow-up
  10. 10. Continuing Care  Pre- and post-discharge checklist for physicians: • Participate in a pre-discharge conference call with the treatment centre. • Ensure you receive a copy of the patient’s continuing care plan. • Partner with the patient by making regular appointments for follow-up. • Provide empathic, supportive care during the extended process of periodic reevaluations, adjustment of treatment, and relapse prevention. • Discuss successes and setbacks with the patient by asking
  11. 11. Motivational Approach Motivational Interviewing: An Effective Technique in Recovery Support. Contributing writer Gloria Dickerson interviews SAMHSA's Steven Samra on motivational interviewing and applying those techniques in recovery support.2014
  12. 12. Stages of Motivational Interviewing  Engage.  evoke .  plan.
  13. 13. Engage Clinicians begin by engaging the patient—by asking permission and gathering the patient's perspective about a behavior that warrants change.
  14. 14. Evoke  Identify the patient's motivation to change.  Highlighting discrepancies between wanting and not wanting to change, and/or acknowledging .  Addressing any resistance to change.  In cotext, provide feedback and medical advice, helping the patient form connections between use and medical problems or other potential risks.  The most important thing is to elicit reasons for change.
  15. 15. Plan The patient identifies steps to take toward change, and the clinician summarizes what has been said and reviews future steps.
  16. 16. Motivational Interviewing Skills The 4 core MI skills are summarized in the mnemonic OARS  Asking Open-ended questions.  using Affirmations.  forming Reflective statements, also known as reflective listening.  providing Summaries, also a form of reflective listening.
  17. 17. Motivational Interviewing Skills Reflective listening does not involve:  giving advice ????  asking questions  providing solutions  moralizing  lecturing  Sarcasm .  Confrontation.
  18. 18. Motivational Interviewing Skills An easy way to do reflective listening is to start with any of the following:  “So…” ‫اذا‬  “Sounds like…” ‫يكون‬ ‫ممكن‬ ‫الموضوع‬‫زي‬  “What I hear you saying is…” ‫انك‬ ‫فهمته‬ ‫اللي‬‫عايز‬ ‫تقول‬ and then repeat or paraphrase what the patient said.
  19. 19. Motivational Interviewing Skills  communicate respect for and acceptance of the patient and his/her feelings.  establish a nonjudgmental and collaborative relationship with the patient.  avoid arguments.
  20. 20. Motivational Interviewing Skills, Evoke An important tool of MI is to develop discrepancy between the client’s current behavior and his or her goals or values .
  21. 21. Motivational Interviewing Skills, Evoke A mnemonic that can help clinicians identify possible “change talk” is DARN-CATs.  D: Desire statements about changing (I wish, I would like to…)  A: Ability statements about one’s capability to change (I think I could, I am able to…)  R: Reason statements that present specific arguments for change (I know I would feel better if, I would worry less if…)  N: Need statements regarding feeling an obligation to change (I should, I ought to, I have to…)  C: Commitment statements: “I want to,” “I could,” or “I need to.”  A: Activation statements reflecting patient’s commitment to actions they will take to change (low-level intention—I hope to, plan to, will try to; higher-level commitment—I will, am going to, promise to, I’m ready to, prepared to…  T: Taking Steps: Actions they have taken: I went to a support group, I got rid of my stash…
  22. 22. Motivational Interviewing Skills Resistance behaviors can manifest as:  Excuses.  Blaming others.  Denials.  Pessimism.  initiating arguments.
  23. 23. Motivational Interviewing Skills if resistance emerges, there are strategies for dealing with it.  Reflection.  Clarification.  Shifting focus.  Emphasize personal choices. ??????? Useful,but not sure in every situation.
  24. 24. AfTER Evoke … PLAN TO CHANGE
  25. 25. CHANGE The 3 Rulers of Change  Readiness.  Importance.  Confidence.
  26. 26. Negotiating a Plan for Change Change comes in many sizes and shapes—it might be as simple as:  Thinking about how to stop using drug /alcohol.  Committing for a follow-up visit.  Committing to working with an addiction counselor.  Decreasing the frequency or amount of drug /alcohol use.  Stopping use for a few months.
  27. 27. Conclusion  Recovery is the utmost result of intervention with addicts.  Recovery needs a set and a tool to be accomplished.  Recovery’s set includes detox and continuing care.  Recovery’s tool includes change process.  Motivational interviewing offers the simple and tasteful approach for continuous change and continuous recovery.???the patient is not

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