Domain II: Treatment Planning, Collaboration, and Referral Boring client - ✅desires attention but does not know how to command it; may be scared or inhibited; reinforce behavior when clt show spontaneity Silent client - ✅fear of disclosing personal information; fear of unable to control situation; can be sign of manipulation or control situation; encourage clt to participate in group; may be necessary to remove clt from gp Self-righteous client - ✅this may stem from sense of failure and inferiority; constant need to be right; inform gp about this type of beh and its causes; usually grow up in dysfunctional home Monopolizing client - ✅demands counselor's full attention; his/her problem are worse than other; annoying and disruptive in group; counselor should address it and ask gp why they allow the behavior; point out the listening is impt part of therapy Hostile client - ✅may be to ver fear; reacting to someone due to transference; help clt handle fear that causes hostility and help find appropriate ways to express emotions T/F: Treatment should be restrictive as possible. - ✅False, unrestrictive Treatment plan - ✅based on screening and assessment; individualized; note problems, goals, objective, and intervention Assessment forms - ✅these are the basis for the treatment pan, which is individualized Planning stage - ✅counselor ad client list and rank clt's problems Goals - ✅should be SMART Objectives - ✅measurable steps taken to achieve goals Relationship between substance abuse and homicide - ✅Due substance abuse, one's judgement is impaired and less inhibited. 50% of incarcerated for homicide were abusing alcohol/drugs at time of incident; avg 18 drinks; 66% perp for domestic homicide (female death); alcohol leading cause of car homicide/manslaughter Relationship between subtance use/abuse and family violence - ✅-40-60% intimate partner abuse related to substance abuse
-85% of victims of intimate partner abuse are female, victims likely to self medicate -35% child abuse perp abuse/use drugs/alcohol Cycle of Drug and Alcohol Abuse - ✅66% of adults who abuse alcohol/drug had hx of child abuse. Why do clients engage in self- harm? - ✅release tension and psychological pain; those who abuse alcohol/drugs are at high risk for engaging in self-harming beh. When should treatment plan be modified? - ✅problem resolved, new problem, relapse, clt's request, no progress, support sys changed, clt unable to participate in interventions (health, transportation, insufficient funds) How can counselor support clt's self-efficacy? - ✅encourage hope and idea that change is possible; focus on strengths and believe in clt's capacity to improve/change; peer support w/ clt's permission; psychoeducation; praise small progress Referral - ✅directing clt to appropriate agency when counselor/program unable to meet clt's needs, also include after/continuing care. Scope of practice for substance abuse counselors - ✅they cannot diagnose/treat mental health d/o; only substance abuse-related thus impt to collaborate with other providers ASAM Levels of Care (American Society of Addiction Medicine) - ✅0.5: Early Intervention I: Outpatient Services II: Intensive Outpatient Services/Partial Hospitalizaiton III: Residential/Inpatient Services IV: Medically Managed Intensive Inpatient Services Level of Care Utilization System (LOCUS) - ✅Basic Svs Outpt Low Intensity Community Based Services High Intensity Community Based Services Medically monitored non-res Medically monitored res Medically managed res Quadrants of Care - ✅Quad 1 - low-lvl substance abuse problem and minor mental health (outpt mental health or substance abuse progr) Quad 2 - low-lvl substance abuse prob and severe mental d/o and(mental health sys) Quad 3 - high-lvl substance abuse prob and low-mod mental d/o
Quad 4 - 1)serious psychiatric d/o and severe SUD 2) severe behavioral health(suicide/homicide) and severe SUD; requires intensive, residential to address both Consultation - ✅meeting with other experts to provide complete quality care; goal is to provide comprehensive tx for susbtance abuse T/F: CLTS in the first 6 mos of treatment are at-risk for relapse - ✅True Detoxfication - ✅first step in recovery from drug abuse physical cravings and mood changes - ✅associated with drug addiction and must be alleviated 3 categories that need detoxification - ✅1)CNS depressants, like alcohol 2) opiates 3) cocaine Detox process from opiates - ✅substitution of another longer-lasting opioid, like methadone, w/c is decreased gradually; CNS electrostimulation and acupuncture can relieve withdrawal sx. Self-directed support - ✅focuses on self-determination in recovery and allows clt to choose about type of recovery prog, with prof. guidance. 4 Drugs to Treat addiction - ✅1) Agonists - mimics effects of drug of abuse;alleviate withdrawal sx 2) Antagonists - block effects of drugs of abuse, w/ch prevent psychoactivity 3) Antidipsotropics - cause adverse reactions to consumption of drug of abuse; antabuse (alcoholics) 4) Psychotropics - control sx with use and withdrawal; anxiolytics, antipsychotics, antidepressants T/F: Pharmacotherapy has found to be useful in treating psychological dependence. ✅false, physical dependence Stages of Recovery - ✅1) Initiation 2) Early abstinence 3) Maintenance 4) Advanced recovery Initiation - ✅clt committing to controlling addiction and enters a program out of his own volition Early abstinence - ✅1st 90 days, withdrawal and at-risk for relapse due to psychological and physical cravings; need to learn coping skills to avoid relapse
Maintenance - ✅after 90 days; focus on relapse prevention and learning about triggers; focus in relationship improvement and anger mgt; lsat 5 yrs Advanced recovery - ✅free of addiction >5 yrs, must stay vigilant, may need 12-step mtg or ongoing support gp/counseling T/F: It is possible that clt in recovery may substitute addiction from drugs/alcohol with other things/activities. - ✅True, exercise, food, sex, pornography, gambling, shopping, work Types of Remission - ✅Early remission - no criteria for SUD has been met for 3-12 mos, except for craving criteria only Sustain remission - no criteria met expcept from craving for >1yr * specify if clt is in controlled environment Maintenance Therapy - ✅Replacement medication that can be taken to avoid withdrawal symptoms. The client could still be considered in remission from a substance use disorder if while using this, they do not meet any criteria for that substance use disorder except for craving. Examples: nicotine replacement systems (tobacco), methadone (opioid) Types of Treatment Programs - ✅1) Residential - for those who need stable environment or have serious substance abuse problem 2) Inpatient hosp tx prog 3) Therapeutic community prog - residential and highly structured environment; selfhelp; ex-addicts are employed as counselor 4) Outpatient non-methadone tx prog - private clinics, mental health centers; tx in community 5) Combined settings - inpatient and outpatient Treatment Approaches for SUD - ✅Self-help; individual/group counseling; family therapy; behavioral modification (+/-consequences to shape beh) Interlinking systems - ✅Collaboration between mental health, substance abuse treatment, and justice sys Substance Abuse Treatment Systems - ✅involves a wide variety of services that are organized into programs designed to treat various types of substance abuse d/o; not all programs have the same approach; e.g., methadone and therapeutic communities; concerned with stabilization, tx, rehab, and relapse prevention Mental Health Service Systems - ✅provide crisis intervention, stabilization tx, ongoing tx, and rehab support;address both acute and chronic d/o
Comprehensive Continuous Integrated Sys of Care - ✅model of care; aim to integrate mental health tx sys and substance abuse tx sys to provide comprehensive, continuous care Addictive Voice Recognition Technique (AVRT) - ✅published by Rational Recovery, to aid substance abuses in self-recovery; educational materials based on ideas: most people recover w/o help from professionals/recovery gps, commitment to abstinence lead to abstinence, recovery is easier than it is made out to be, role of counselor to convince clt that he can quit, addiction as survival drive linked to pleasure; intoxication is a decision, individual can learn to identify as a non user Moderate Management - ✅self-help gp that provides support for individuals who wish to cut back on their drinking til it does not cause problems; weekly meeting, anonymous, and no fee Women for Sobriety - ✅help females quit drinking; 13 positive statements to encourage women to learn new lifestyle and to overcome alcoholism Save Ours Selves - ✅Secular Organization for Sobriety; sobriety and religion are separate issues; individual responsible for his own sobriety and given credit for it. SMART Recovery - ✅A treatment program for abuse of alcohol and other drugs that emphasizes a nonspiritual philosophy and a greater sense of personal control in the abuser. SMART stands for "Self-Management And Recovery Training." 12-Step Program - ✅like AA, no fee; some use it as main treatment others for aftercare. Minnesota Model - ✅A major model in the treatment of alcohol and drug abuse, involving a month-long (up to 60 days) stay in an inpatient rehabilitation facility, a multidisciplinary treatment team, systematic assessment, and a formal treatment plan with long and short term goals; incorporates 12-step model AA - ✅Alcoholics Anonymous; maintains anonymity of the member God in AA - ✅AA developed in 30s and 40s by Bill W., who expanded the 6-step to 12step and reference to higher power 12-Steps - ✅1. admission that clt is powerless regarding alcohol use 2. acceptance of, and faith, in greater power 3. Made a decision to turn our will and our lives over to the care of God as we understood Him. 4. Moral inventory of ourselves. 5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Ask God remove all these defects of character. 7. Ask Him to remove our shortcomings. 8. Listing of wronged individuals 9. Making amends 10. Personal inventory 11. Seeking God through prayer 12. Passing on of a spiritual awakening other Chip meeting - ✅similar to a birthday meeting that a period of time sober is rewarded; 1 day, 30 days, 6 mos, and 12 mos sobriety Harm Reduction Model - ✅Approach to treating substance use disorders that views alcohol use as normative behavior and focuses education on the immediate risks of the excessive use of alcohol (such as alcohol-related accidents) and on the payoffs of moderation (such as avoidance of hangovers); - focus on teaching CLTs about negative consequences of substance abuse and guiding them to carry out other methods to reduce risk; often used with legal drugs, like alcohol nicotine, and prescription drugs. - clt are responsible to reduce risk Objective documnetation - ✅- observable/measurable behaviors E.g., - narrative, chronological report of clt's condition, tx, and responses - SOAP, problem-oriented form of charting - PIE (problem intervention evaluation), less complex than SOAP, use flow sheets - Focus/DAR (data action response), focused charting