Assignment: Psychotherapy for Clients With Addictive Disorders

Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families.

To prepare:

Review this week’s Learning Resources and consider the insights they provide about diagnosing and treating addictive disorders. As you watch the 187 Models of Treatment for Addiction video, consider what treatment model you may use the most with clients presenting with addiction.

Search the Walden Library databases and choose a research article that discusses a therapeutic approach for treating clients, families, or groups with addictive disorders.

The Assignment

In a 7- to 10-slide PowerPoint presentation, address the following. Your title and references slides do not count toward the 5- to 10-slide limit.

Provide an overview of the article you selected.

What population (individual, group, or family) is under consideration?

What was the specific intervention that was used? Is this a new intervention or one that was already studied?

What were the author’s claims?

Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own clients. If so, how? If not, why?

Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.

Use the Notes function of PowerPoint to craft presenter notes to expand upon the content of your slides.

Support your response with at least three other peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Provide references to your sources on your last slide. Be sure to include the article you used as the basis for this Assignment.

187 Models of Treatment for Addiction video, consider what treatment model you may use the most with clients presenting with addiction. Case study

I’d like to welcome to everybody to today’s presentation on the models of treatment. So what we’re really going to talk about is some different theoretical

approaches because not all of us necessarily ascribe to the same

theoretical approach and when we’re working in multidisciplinary teams sometimes we have to think about the different influences from each person in

that team in order to make a compelling argument for what we want to have happen

in order to create that win-win situation so that’s kind of what we’re going to look at today we’re going to define the principles of effective

treatment which hey you know good to know explore current trends and practices in treatment programs and those are rapidly

changing some of the things that we used to do we don’t do anymore and some of

the things that we haven’t been doing we may start doing in the not so distant

future so I’m going to interject a little bit of new stuff as it relates to the President’s Commission on opioid use or whatever it was called that report

that just came out will identify some common approaches to treatment the main components of each approach we’re not gonna go in depth we’re just gonna kind

of hit the highlights like I said so you can figure out if you’re working with somebody who uses that theoretical framework how to create a win-win and

how to work together harmoniously and we’re going to compare and contrast each approach a little bit in terms of which clients you might use it with and how it

might work in different settings such as mental health sandal own private practice versus community behavioral health etc and maybe different ways that

you might be able to implement it so principles of effective treatment addiction and mental health issues are complex but treatable conditions that

affect the brain the body and behavior so this is one of the new changes and we’ll talk about that later but we’re really focusing on the whole person

now we recognize that it’s not just the way somebody thinks it’s not just their neurotransmitters it is a whole brain body behavior thing and any change in

any one of these areas can affect the other area so if you start making better behavioral choices then potentially like we talked about yesterday with people

with alcohol-related brain damage if they make better behavioral choices chances are their brain health is going to improve and their body health will

improve and their mood theoretically will improve – no single treatment is

going to be appropriate for everyone so when people come into our clinic or facility or whatever you call the place that you work we can’t necessarily

assume that group 12-step treatment or individual humanistic counseling is

going to work for them we need to look and say what does this person need now individual humanistic may work in terms of addressing the cognitions and the

mental health stuff but they also may need some brain body stuff with either a

psychiatrist or a physician and maybe some social skills or something else so

we need to look at the comprehensive picture treatment needs to be available

to be effective and you’re thinking well duh but in the big scheme of things when

we look at how many people actually are able to access treatment only about 10%

of people with addictions are able to access specialized treatment each year

and the numbers a little bit higher for mental health but it’s not you know wonderful you know less than 50% of people who have treatable mental health

conditions receive treatment so we want to look at why is that and one of the

reasons soapbox warning is because treatment is too expensive for a lot of people they have deductibles that are $1,300 and up I look the average

deductible for a person a single person is $1300 which means insurance doesn’t cover anything

until they pay the first thirteen hundred dollars out of pocket now if a clinician charges a hundred dollars a session that’s thirteen sessions which

could be virtually the entire course of treatment before insurance even kicks in and a lot of people don’t have that kind of money just kind of laying around so

we want to look at the affordability and availability of treatment which is one of the reasons I push groups a lot because groups are a way that we can

provide a lot of services for affordable amounts for the clients and still you

know put food on our own tables so looking at how can we as clinicians make

treatment more available to those in our community virtual services that’s

something that we can look at telemental health so people don’t have to get babysitters don’t have to travel group therapy having services on the weekends

or or during the evenings those are always great now you’re thinking well that’s what I want to be with my family true so it’s always a trade-off you got

to figure out you know could you do evenings two days a week or something in order to be available and that’s something that you know is a choice that

you’ve got to make on your own I know when we were setting up new programs we would always look at where the demand was where did we have the waiting list

was it the morning programs or was it the evening programs and you know what kinds of services were in highest demand so effective treatment attends to the

multiple needs of the individual so we’re not just doing that mental health assessment and going okay you’ve got you need the criteria for major depressive

disorder so we’re gonna treat that and we’re going to talk about all the reasons that you’re depressed well effective treatment is also going

to look at their nutrition their social their living environment is their stress their their work environment and you know attending to any medical needs that

may need to be addressed to also deal with the depression current trends and

practices focus on the client competencies and strengths instead of saying we’re going to get rid of your depression we’re going to say we’re

going to help you feel better yeah it’s the same thing but instead of getting rid of something we’re adding something we’re putting something

awesome in its place and one of the principles of behavior modification is

that you don’t want to just punish a behavior you don’t want to just get rid of things because if you get rid of it you have to have something to put in its

instead and that’s one thing that we want to ask what are we working towards what’s our goal and what strengths does the person have maybe their social

skills are weak okay you know maybe they’ve got a lot of social anxiety that contributes to their other mood issues okay

well we’ll deal with that but let’s look at what strengths they have maybe they’re really articulate maybe they’re really smart maybe they are introverts

and they just don’t really realize that people who are introverted tend to get more stressed out in large groups so we can help educate them about their

strengths as an individual so we want to focus on strengths and build clients up we want to focus on what’s worked in the past instead of saying okay you’re in my

treatment program let’s start at square one we’re saying okay you’re in my treatment program what’s worked for you before so let’s build this foundation

and figure out what kinds of tools you already have in your toolbox before we start trying to put more stuff in there and that will also help us figure out

like I said what’s worked before if see cognitive behavioral hasn’t worked for

them before then we don’t want to throw a bunch of cognitive behavioral tools in their direction we might ask what about it didn’t work for them so we can you

know make sure that we’re going down the right path but we’re going to figure out for that person what helps the most and the CBT works well for people who have

um unhelpful thoughts and cognitions sometimes but sometimes if they’ve got

emotional dysregulation they may feel like the clinician just doesn’t get how

intense this is when the clinician says well you just need to change the way you’re thinking about things they’re like it ain’t that easy doc so we want

to make sure that we provide individualized client centered treatment and shift away from labeling you notice I try really hard not to say addicts

alcoholics I say people with addictions or addictive issues I try not to say a

person with depression I try to say a person who has depressive symptoms

because I want to look at the person I want to emphasize that the person is in

there and for me when I say a person with depressive symptoms that reminds me

that depression doesn’t look the same for most people you know there there’s a

huge variation and what depression looks like so I want to look at that person

and what symptoms they’re prevent presenting with acceptance of new

treatment goals other than for example with with substance abuse or addictive

behaviors abstinence there are some addictions especially the behavioral

ones but even eating disorders that you cannot completely abstain from you can’t

not eat you could argue the point about sex addiction some people say well you

don’t have to ever have sex you know when we’re talking about the totality of

the human organism that’s a choice that each person has to make but those are

the things that we want to look at in in terms of what is the person willing to

do and what is going to help them lead the healthiest and happiest life what

does happiness look like for them for some people you know their definition of

recovery from depression may be very different from mine but I want to look at what are their treatment goal adoption of a recovery paradigm away

from problem focused acute care model which means we want to help them figure out how to achieve a rich and meaningful life not just eliminate depression but

we also want to look at a recovery paradigm a recovery network if you will

it’s not just your symptomatic right now we’re gonna treat it right now it’ll go away when it comes back you come back for more treatment you know because we

know that people who have major depressive disorder for example will have recurrences most likely what we’re looking at is okay let’s treat what

you’ve got going on right now let’s help you start feeling better and help you continue to feel better ie not relapse and have another episode

so we want to make sure that we’re looking not just at eliminating the present symptoms but keeping them away integration of addiction treatment in

multiple disciplines especially primary care mental health and addiction so we

want to make sure that addiction counselors know the basics about working

with clients with have mental health issues we want to under the primary care physicians have an understanding of how to screen for substance use issues

evidently less than 20% of primary care physicians ever receive training in that

that was from the report that came out anyhow and we want to make sure that

each area is aware of the impact of the other areas so mental health practitioners are aware of the impact of even behavioral addictions like we’re

talking about Internet addiction which is in the dsm-5 and other other sort of sorts of behaviors we also want to make sure

they’re aware of the impact of physiological problems like polycystic ovarian syndrome and hypothyroid okay another trend is the use of

evidence-based practices and if you are in a clinic you’ve probably heard about this if you are in individual practice you may not have but I do want to show

you this really cool little tool and I will deficit by saying evidence-based practices are awesome

however in many circumstances about 85% of them require you to get go through a

certain training curriculum or whatever that can be quite expensive which is why

a lot of agencies have difficulty adopting new EB T’s because it requires that every staff member be trained on it and that training is often several

thousand dollars so the new mandate that we start using that came out that

treatment facilities start using evidence-based practices well that’s wonderful we’ve been saying that for

we’re working with adolescents sure why not outcome categories mental health race ethnicity so we’re getting to more

detail about what’s going to work with this population let’s say

worked with actually have a line item in there that says you need to consider the use of medications for treatment and telehealth technologies are becoming

huge partly because it makes services more accessible and to a little extent a

little more affordable you’re still paying for the clinicians time and the technology but there are a lot of other ways we can use telehealth such as

support groups in the rooms is an online chat room for people with substance

abuse issues people can log into daily virtual support groups or you can even

host one on your own website if it’s a support group you have less HIPAA issues

especially if you host it on website other than your own you create a secondary arm that’s your aftercare support thing talk to your attorney

about HIPAA and hi-tech confidentiality issues there but there are a lot of

different things you can do you can provide chat support to your clients so they can get more immediate in the moment support for something that’s

going on maybe there in the first month of recovery you can have forums

available forums have kind of gone by the wayside over the past 15 years or

whatever but they still get used some and it allows people to communicate asynchronously and provide each other feedback one that I participate in spark

people it has an app is a nutrition and health and wellness app but there’s a lot of really good interpersonal support that goes on on that in that chat room

so that’s a good place and oh there was another one I met the man the other day

that created pocket rehab is the name of the app and is only available on Apple

devices right now but pocket rehab and he has a really great program that

allows people to both do private journals as well as to receive lifeline

support from other people who are in recovery and he incorporates all

addictions not just substances but also shopping and in Internet addiction and

all those sorts of things so an online video psychoeducation

if you have certain topics that you teach every single group that comes through like when I when I was at the clinic in South in Florida there were

certain groups I did every single 30 days so you can record those and it

doesn’t have to be super fancy it can be like this or it can be super fancy whatever you want and have those available online they can be password

protected so only your clients can get to them if you want to so they can watch them at their leisure and and or you know they can participate in the group

and then they can go back and review the video later if they need sort of a tune-up so how else can we make treatment more

available and that’s one of the things that’s going to kind of plague us because there’s the balance between or struggle if you will between making

services available but we can make them available but we’ve making them

affordable is almost more challenging than making them available a lot of

people kind of shy away from groups especially face-to-face groups because you know they don’t necessarily want to see their neighbor when they walk into a

room online groups have the benefit of people can’t see each other or you don’t

have to do video so people can see each other most of the time they can’t so people feel like they maintain a little bit more anonymity online services

that’s another thing so I would encourage you to continue to think about that principles of effective treatment duration and treatment for at least

three months is generally critical for substances definitely critical for

mental health you know really 12 weeks is not a long time for somebody who’s

struggling with major depressive disorder you know to really get some traction in their recovery now if you’re dealing with some acute adjustment

issues obviously three months isn’t what we’re talking about but you know major

issues that are going on that’s really what we want to look at treatment plans must be assessed continually and modified to assure that it meets the

person’s changing needs so you’re going along for three weeks and all of a sudden the person loses their job or separates from their spouse or something

else happens or maybe even they get a promotion at work score that’s awesome but you may still need to adjust the treatment plan based on what the

expectations were for that person to do how much time they have to devote to treatment and the current pressures in their life if they get a promotion then

they also might have new added stressors if you will of this new job so you might

have to kind segue over and add that as an additional treatment plan ischium treatment doesn’t need to be voluntary to be effective

you have the flexibility so if they say I’m not going to 12-step meetings for example you can say okay well you need some you need a support group or you

need some sort of pro-social activity so many hours a week what are you going to do instead the medical model of treatment looks at these issues mental

health and substance abuse more as a chronic disease issue with mental health

we’re looking at neurotransmitter imbalances with and we also have

neurotransmitter imbalances with addiction these treatments are often hospital or doctor’s office based so you may be working with somebody it’s likely

that you’re working with somebody who is also seeing their primary care physician or a psychiatrist for psychotropics okay so if you are

that’s fine but we need to look at it and say okay that person is addressing

this aspect of the depression or the anxiety or the addiction I’m going to

address this aspect over here we’re not really going to overlap but as the clinician we probably are the single point of contact so we need to make sure

everything is merging together well the medical model does use a biopsychosocial

approach with an emphasis placed on physical causes and pharmacotherapy but

they do look at the psychological and social aspects a little bit and the

doctor may make some recommendations but he’s not gonna do counseling and he’s not gonna do life skills training you may see people get detoxification

medication for symptom reduction medication for a version like antabuse

which is what they used to give alcoholics and they do still some and medical maintenance or medication assisted therapy the spiritual model

views mood issues and addiction as being caused by spiritual emptiness which

leads to character defects such as pride resentment and anger now the 12-step models are largely based in the spiritual model but you also

might be working with somebody who’s been working with their spiritual guide or their spiritual leader so we want to be able to understand where that person

has been telling the client this is probably what’s causing your your issues right now less weight in the spiritual model is given to causation and more of

an emphasis is put on a spiritual path to recovery development of values and a sense of meaning and purpose so what we’re looking at developing hope faith

courage discipline those sorts of things which really won’t hurt anybody the

12-step models which are mutual help and many people aren’t real familiar with

twelve steps they’ve heard about them they know well if somebody has a substance use issue they go to a a or NA well there’s a lot of a programs out

there a lot of Anonymous’s they emphasize that one cannot help once

self and recovery requires surrender of one’s will to a higher power now for

some people as soon as they hear that their skin starts to crawl and they’re like oh heck to the no and for other people they embrace that and go you know

what you’re right I’ve been trying and trying and trying and I can’t do it on my own so one of the challenges we have if we’re working with somebody who

either doesn’t believe in a higher power or who is angry at their higher power how do we help them embrace that and one tool and I’m going to ask you to think

about other ways we can help people integrate into 12-step communities if they don’t believe in a higher power but one tool that I’ve always been taught is

to view God as good orderly direction that is to get to your goals to get a

reaching meaningful life always think first before you act is what I’m getting

ready to do going to help me move in a good orderly direction towards my goals or is it gonna you know throw me off track so if we’re thinking about good

orderly direction in terms of a higher power or a higher direction sometimes

that can help people deal with 12-step meetings if they were a bit resistant

because sometimes the court just requires 12-step meetings and you can’t

you have no way to get around it you can advocate till you’re blue in the face and it ain’t gonna help so one thing that I do want to point out with that is

emotions Anonymous I said there’s a lot of eyes out their emotions Anonymous is

designed for people basically who have emotional dysregulation issues where their emotions they go from 0 to 240 and 1.2 seconds and they feel like they’re

not able to control their anger their depression their anxiety any of those

dysphoric feelings if they’re willing to explore a 12-step sort of approach ei is

a good activity for them they have their own literature they have their own books the meetings are not nearly as plentiful as

there are aana meetings around but they’re always open to people starting

new meetings so if you’re interested in learning more about it maybe starting a meeting at your facility that could be an avenue that you go down okay so how

can you use a spiritual model with clients who don’t believe in a higher power and for me it comes down to working with them to define what

spirituality means to them and in what way they think spirituality or lack

thereof or spiritual roadblocks are contributing to their unhappiness right

now and so we get into a much more abstract conversation about what’s going

on and talking about what does recovery look like and if you’re recovering

spiritually if you were a coverage spirit spiritually what would be different what do you need to enhance are we talking virtues or what behaviors

and we kind of pick that apart for a little while to develop their ultimate goal plan

okay the psychological and self-medication model says that addiction and mental health issues result from deficits in learning

thinking or emotion regulation so this is the stuff we were all taught in grad school treatments can be ranged from behavioral self-control to individual

and group counseling to pharmacotherapy I mean we’re not opposed to helping

people figure out what may need to be addressed and advocate for them or

encourage them to advocate for themselves with their physicians in order to access pharmacotherapy that might help them so the goals will start

with behavioral self-control training behavioral self-control is you know think back basic behaviorism strengthen internal mechanisms so increased

self-awareness of what’s going on what you need what your triggers are or your stimuli and establish external controls so you can implement coping skills help

people start learning how to set goals so they have something out there that they see I need to accomplish this this week or this this month or whatever it

is and they have this external plan that’s helping them monitor and shape

their behavior you can use behavioral contracting so for example what would

you contract for with somebody who has major depression who has difficulty getting out of bed we may contract for having the person get up by a certain

time each day and you put in rewards for achieving that and if they don’t achieve

it then we want to look at you know what what’s going on what happened there but each day just like with standard behavioral interventions if they do what

they’re supposed to do or trying to do we need to make sure that it’s rewarding so if they do get out of bed at whatever time you you identify

we need to make sure they have access to some sort of rewards trigger management so encouraging people to be aware of what their triggers are I’ve told you

before one of my four as far as mental health mood triggers is the commercials

identify what those

triggers are and figuring out how to work with and or through them functional

analysis of the behaviors not the diagnosis so if somebody has symptoms of

depression they meet the criteria for major depression whatever you want to say all right we’re not going to look at what is the function of depression well

depression looks different for different people what is the function of not being

able to get out of bed not feeling you know they just don’t want to get out of bed in the morning that’s the behavior so what’s motivating that well they may

not be sleeping well they may feel fatigued and exhausted okay let’s look at what’s causing that because then we can figure out something to address the

underlying issue that’s causing the targeted behavior the behavior you want to eliminate so conducting those functional analyses if somebody stress

eats okay so that’s a specific behavior so what purpose does it serve and what else could you put in its place to satisfy it

this need instead of stress eating relapse prevention so we want to look at

relapse prevention strategies for both mental health and addiction and they’re basically going to be the same good sleep good nutrition good social support

mindfulness relaxation and recreation you know regularly I won’t say every day

because some people just they work too jobs have six kids can’t do it okay that’s fine but we want to make sure that these people are living or trying

to live a happy healthy life so that’s what relapse prevention is is helping the person prevent those conditions prevent it stuff that caused the

neurochemical imbalances that led to their depression which may have led to

their unhelpful thinking so you know wherever the unhelpful thinking came in

the process you know it doesn’t really matter we end up needing to treat or address everything but realizing that relapse prevention means preventing

those conditions from occurring again just like when there’s a hurricane there’s a certain set of conditions that have to happen for hurricane to form

well there’s a certain set of conditions for each person that need to kind of occur for them to have a recurrence of their major depressive episode in most

cases like 99% of the cases so we want to know what those are so we can try to

prevent them and we don’t want to know what those are and what the symptoms are

of the beginning of an episode so people can intervene early if they notice you

know what I’m starting to feel kind of wonky then they can start saying I need to back off maybe I need to take this weekend off and rest and relax because

I’m starting to get burned out and I’m starting to feel blue and I really don’t want to go into a whole depressive episode that’s relapse prevention so

preventing an early intervention dialectical behavior therapy came as a

response to people who weren’t doing well with traditional cognitive

behavioral clients in traditional cognitive behavioral often and traditional therapy often unintentionally reward ineffective

treatment while punishing therapists for effective therapy with a lot of clients

when we start digging when we start pushing buttons when we start helping them move through those stuck points it hurts and they don’t like it so in

certain circumstances among certain groups of people they symptoms escalate so much that the therapist has to back off every time

they start to get to a point the client either discharges or rapidly escalates

or decompensates so cognitive behavioral wasn’t helping to deal with the distress

do how can you address it emotion regulation and interpersonal

effectiveness and problem solving a lot of people who have emotional dysregulation have difficulty managing those emotions and not going from 0 to

240 and 1.2 seconds they’ve had struggles with interpersonal

relationships a lot of people with borderline personality disorder characteristics also struggle with relationships because of their lack of

internal sense of self their need for external validation so more interpersonal effectiveness skills need to be taught but they also need to be

able to regulate their emotions and their distress another model that you

might not be familiar with but has a lot of really awesome units for straight-up

mental health is the matrix model for stimulant use now if you’re going to use it as an evidence-based practice obviously you’re using it with stimulant

abusers but this manual for the matrix model provides you with worksheets I

mean it’s it’s a clinicians manual for identifying triggers body chemistry and

recovery thinking feeling and doing work in recovery guilt and shame sex and

recovery truthfulness trust being smart not strong talking about asking for help

so there are a lot of really awesome things that you can get some ideas off

of to do group if nothing else the goals of the matrix model are to learn about

issues critical to addiction and relapse receive direction and support from a

trained therapist and become familiar with self-help programs not just 12-step but that can include celebrate recovery and some of those others the therapist

functions simultaneously as teacher and coach fostering a positive encouraging relationship so a lot of this is psycho-educational like I said it a lot

of the groups are applicable to people who don’t have any addiction issues at all motivational inherent enhancement

therapy is unique because it usually only consists of three to five sessions

period and a story it’s used to help resolve ambivalence about treatment and

abstinence or change whatever the change may be and that can be relationship

issues or whatever the therapy consists of initial and assessment battery

because you want to get an understanding of what’s going on in this person’s life so you can provide them feedback followed by two to four individual

sessions with the therapists and they’re not usually weekly they’re spaced out where you develop goals and you empower the person to make

Changez on their own the first treatment you want to provide feedback about the

initial assessment place the responsibility for change directly on the shoulders of that person saying you know what you got this but I can’t do it

for you I am here to advise as much as I can but ultimately if you’re going to

change it’s the balls in your court so we want to elicit self motivational state statements identifying the reasons they want to do it and examples of how

they’ve succeeded in the past so self motivation and self-efficacy we want to strengthen motivation and build a plan for change so this is still the first

session it’s a long one we provide advice such as coping strategies for

high-risk situations then we provide a menu of options so here’s some advice

about you know different directions you could go here’s a menu of options for different types of treatment different books you could read you know these are

things I think would help you here’s a laundry list now let’s figure out what looks good to you we want to provide empathy and enhance self efficacy

so feedback responsibility advice menu of options empathy and self-efficacy in

the subsequent sessions the therapist monitors change reviews the change strategies being used and encourages change you’re the cheerleader at that

point so this is very behavioral in nature and motivational in nature and

puts a whole lot of responsibility on the person which means it’s really good for some people who are really high functioning and really motivated family

behavior therapy I really like it’s demonstrates positive results in both adults and adolescents it addresses not only substance use and mental health

problems but other co-occurring issues because it’s family behavior therapy not identified patient behavior therapy so we’re looking at a whole family going

alright what’s going on here it can start addressing conduct disorders child mistreatment family console unemployment you know the range of

things goes on we figure out what are the weak links if you will or the

trigger points in this family that are causing the identified behaviors what

they want to get rid of and how can we help them meet those goals it involves

the patient along with at least one significant other such as a cohabitating partner or a parent so it doesn’t have to be the whole family ideally it is

everybody living in that household but it requires at least one other person

FBT combines behavioral contracting with contingency management so you set up a

contract you agree to do these things if you do there are certain rewards that you can get and they set up the rewards therapists seek to engage families in

the family system it looks at the environment and addresses biopsychosocial spiritually environmentally the trigger points that

people who have active substance use issues so you can take that substance group kind of out of it because this is really looking at PTSD recovery and

creating safety the socio-cultural model emphasizes the socialization process

culture observational learning and reinforcement of behaviors so somebody

using this model is really going to look at the social and family relationships and in substance abuse recovery we often say that people need to change people

places and things well that’s easy to say but it is almost impossible to do

for most people they’re going to go back to that same environment out of which they came because that’s the only place they have to go they don’t they can’t

afford to go to a sober-living facility that may charge $1500 a month or something so they’re going back home so changing the culture that they live in

they live in the same neighborhood you know whatever that’s not so easy but we

can help them develop skills and tools to deal with the stressors in their

family and social relationships in their environment we can help them develop

social competency and interpersonal effectiveness playing on the observational learning if they see John and he’s doing he’s he goes drinking

when he’s had a bad day and it seems to help him feel better and your client says well maybe I had a when I have a bad day go out drinking we want to

encourage him to think what are your ultimate goals and is following what John does even though it looks like it might help is that really going to help

you is that going to be the solution that you’re looking and encourage people to work within their own cultural infrastructure to

find a safe place you know what is it that I can do where so I’m remaining

true to my culture as I define it but I’m also happy and healthy and all those

sorts of things relapse prevention is a really basic approach and it adopts strategy is designed to help clients become aware of

cues or triggers that make them more likely to abuse substances or become

symptomatic triggers and I’ve told you before that um you know it can be

holidays it can be seasons it can be smells it can be there are a variety of

things I know for me there are certain smells that trigger really positive memories and certain smells that trigger trauma and I’ve learned how to deal with

those triggers through practice and experience but it’s important for

clients to be able to recount if they have a smell for example that triggers a

traumatic memory for them to be able to stay in the present and not you know go

back there wherever back there was so relapse prevention helps people be a lot

more cognizant of their environment and more mindful one of the things that we don’t we don’t usually use the words mindfulness and relapse prevention

together but you can’t have one without the other mindfulness helps clients identify when they start feeling that queasy little

feeling that pit of their stomach that says this is not a good place for me to be or this is gonna be stressful so they can address it early that early

intervention and it helps them look around and eliminate as many triggers as possible so they can have positive things around

if they’re say particular you know billboard on their way to work that

triggers them they can go a different route if they see maybe they’re driving past the neighborhood where they used to live with their expose and that just

devastates them every time they drive by it or it makes them really angry well maybe they can find a different to work so monitoring and managing those

triggers so they’re not intentionally putting themselves in stressful or dangerous high-risk situations and helping them develop alternative coping

responses to those cues all right so you have to drive by your old neighborhood you get enraged when you drive by there and you’re thinking about what happened

and I can’t stand it what can you do how can you get out of that flurry of

adrenaline and get yourself to a place that’s more helpful for you for some

people you know one thing I might suggest for a client who has to do that is to think alright if they know ahead of time they’re gonna have to drive by

that place what can they do leading up to it positive self-talk leading up to it and distraction techniques as they pass it so maybe having their favorite

song really loud on the radio or the comedy channel on or something that can

help so they get so they get past it or if they have an unreasonable fear of bridges what can you do if you know you’ve got to go over a bridge to get

through it so it doesn’t throw you for for a loop now obviously those are acute responses but enough stressors could potentially

trigger a full-blown relapse of anxiety or depressive major depressive symptoms

medication assisted therapy which allegedly is supposed to be becoming

available at all treatment facilities and I’ll wait to see that happen

includes methadone suboxone vivitrol antabuse and some SSRIs you’re selective

serotonin reuptake inhibitors they’ve been found to help with certain compulsive behaviors certain antidepressants especially zoloft it’s

been found to be really helpful with people with bulimia so there is some evidence out there that SSRIs can help with some compulsive behaviors in

addition to mood issues vivitrol is helpful for alcohol and opiate abuse

antabuse is the thing that people take then makes them throw up and really really sick actually it increases the rate at which they get alcohol poisoning

is technically what happens if they drink so there’s a lot of different

types of medication assisted therapy out there it’s not necessarily meant to have somebody on it indefinitely I help start a methadone clinic where I

came from in Florida and our psychiatrist really looked at it as an 18-month treatment program get people on you know get them to the point where

they’re not having cravings to use then they had in methadone clinics you are required by the Food and Drug not food and drug by the DEA there are all kinds

of requirements for counseling that have to take place in a methadone clinic not in the patient not in the doctor’s offices where people go and get suboxone

that’s generally just getting them suboxone but in methadone clinics people have to undergo pretty intensive therapy in addition to it and a lot of clinics

will only maintain people on it unless there is an overriding reason not to

discharge them for about 18 months to two years you have to present to the

powers that be at the DEA or wherever compelling reasons to keep somebody on

methadone more than two years now some of the people that I worked with that were veterans did have chronic pain they had opiate addiction issues methadone

was being used to help monitor manage their pain you know there were some outstanding outliers or whatever but understand that methadone really for the

most part is not meant to be something that people get on and stay on for the rest of their lives it’s not replacing one addiction with another it’s supposed

to help them get through that period until their neurotransmitters can kick back in and they develop the skills they can they need to develop to deal with

life on life’s terms medication assisted therapy for mental health issues are

your SSRIs SNR is your atypical antipsychotics your antipsychotics some people need those obviously if

somebody has a psychotic disorder or a bipolar disorder they’re probably going

to have to be on medication people with a generalized anxiety and major depressive disorder and some of your mood disorders may not have to be but it

may help them get through until they start getting some treatment traction harm reduction is the acceptance that drug use and mental health issues are

just a reality the goal is to prevent harm caused by severe mental health

issues you know not being able to get out of bed losing your job relationship problems you can have a lot of problems from mental health even if you don’t

have an addiction when we talk about these we talked about the for ELLs just to make it easier to remember liver lover livelihood and law so we

want to prevent health problems we want to prevent relationship problems we want to keep people employed and keep them from getting involved with the law

interventions for harm reduction include low threshold pharmacological interventions so like what we just talked about if we’re talking about

drugs needle exchange programs emphasis on non injection routes of administration such as oral tablets and even smoking and inhalation but

injection int’l a ssin and smoking are the three fastest ways to get high and three most potent so we want to steer people away from those as much as

possible lead more towards oral as as needed and if you’ve got somebody on

other medications you know for some sort of mental health issue I know some of my

clients who had psychotic disorders would have injectable antipsychotics but

we don’t want people ideally injecting themselves every single day unless it’s inevitable but with the antipsychotics a once a month injection of the of the

antipsychotic would keep the person going so they didn’t have to remember to take it so we want to look at harm reduction what can we do to help this

purse an involvement of those with a history of use or distress in program development so to develop a harm

reduction program we need to ask people who have the problem what is going to help you out what can minimize the ancillary problems caused by this

behavior condition or addiction multidisciplinary psychotherapeutic

interventions for co-occurring issues medication assisted therapy for both addictive and mental health issues wraparound services including legal and

child care and social services to ensure people have access to necessary resources to achieve their goals and family therapy to improve the

interpersonal environment of the person now if you can get all those in the same facility awesome but these are all things that we need to consider when

we’re looking at providing a comprehensive treatment program there

are many approaches to dealing with mental health and addiction issues since co-occurring issues are the expectation not the exception it makes sense to be

aware of strategies to address both or all issues or at least where to find those evidence-based and promising practices current trends and practices

are steering clinicians to use more individualized strengths-based biopsychosocial spiritual approaches are there any questions

you