Addiction Counselor Exam Review
Models of Treatment
Objectives
Models of Treatment
• Psychological (self-medication) Model
• Addiction and mental health issues result from deficits in learning, thinking or emotion regulation
• Treatments
• Behavioral self-control
• Individual and group counseling (Multiple EBPs)
• Pharmacotherapy for mental health issues
Psychological: Behavioral Self Control
• Goals
• Strengthen internal mechanisms (self-awareness)
• Establish external controls
• Coping skills
• Goal setting
• Behavioral contracting (What would you contract for?)
• Trigger management (What are MH triggers)
• Functional Analysis (of behaviors NOT diagnosis)
• Relapse prevention (What are relapse prevention strategies for MH? Addiction?)
Psychological: Psychotherapeutic
• Dialectical Behavior Therapy
• Why
• Clients unintentionally rewarded ineffective treatment while punishing their therapists for effective therapy.
• The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format.
• Clients found the focus on change inherent to CBT invalidating. (How might this be true in addiction?)
• Clients felt their suffering was being underestimated, and therapists were overestimating their helpfulness
• “You are doing it, or feeling incorrectly.”
Psychological: Psychotherapeutic
• Dialectical Behavior Therapy
• Over Riding Themes
• Mindfulness (wise mind)
• Distress tolerance
• Emotion regulation
• Interpersonal effectiveness & problem solving
Psychological: Psychotherapeutic
• Matrix Model for Stimulant Use
• A 45 session treatment program
• Goals:
• Learn about issues critical to addiction and relapse
• Receive direction and support from a trained therapist
• Become familiar with self-help programs.
• The therapist functions simultaneously as teacher and coach, fostering a positive, encouraging relationship
Psychological: Psychotherapeutic
• Motivational Enhancement Therapy
• Helps resolve ambivalence about treatment & abstinence
• This therapy consists of:
• Initial assessment battery
• Followed by 2-4 individual sessions with a therapist
Psychological: Psychotherapeutic
• Motivational Enhancement Therapy
• This therapy consists of (cont…):
• First treatment session (FRAMES)
• Feedback about the initial assessment
• Responsibility
• Elicits self-motivational statements
• Strengthens motivation and builds a plan for change
• Advice: Coping strategies for high-risk situations are suggested
Psychological: Psychotherapeutic
• Motivational Enhancement Therapy
• This therapy consists of (cont…):
• First treatment session
• Menu of Options
• Empathy
• Self-Efficacy
• Subsequent sessions: therapist monitors change, reviews change strategies being used, encourages change
Psychological: Psychotherapeutic
• Family Behavior Therapy (FBT)
• Demonstrated positive results in both adults and adolescents
• Addresses not only substance use and mental health problems but other co-occurring issues (i.e. conduct disorders, child mistreatment, family conflict, and unemployment)
• FBT involves the patient along with at least one significant other such as a cohabiting partner or a parent
Psychological: Psychotherapeutic
• Family Behavior Therapy (FBT)
• FBT combines behavioral contracting with contingency management.
• Therapists seek to engage families in applying the behavioral strategies taught in sessions and in acquiring new skills to improve the home environment.
Psychotherapeutic
• Seeking Safety
• Present-focused therapy for trauma/PTSD and addiction
• Available as a book, with guidance for clients and clinicians
• Can be done in individual or group
Psychological: Psychotherapeutic
• Introduction/Case Management
• Safety, PTSD: Taking Back Your Power
• When Substances Control You
• Honesty, Asking for Help
• Setting Boundaries in Relationships
• Getting Others to Support Your Recovery
• Healthy Relationships
• Community Resources
• Compassion
• Creating Meaning
• Discovery
• Integrating the Split Self
• Recovery Thinking
• Taking Good Care of Yourself
• Commitment
• Respecting Your Time
• Coping with Triggers
• Self-Nurturing
• Red and Green Flags
• Detaching from Emotional Pain (Grounding)
• Life Choices
Models of Treatment
• Sociocultural model
• Emphasis is placed on the socialization process, culture, observational learning and reinforcement of behaviors
• Recovery involves:
• Building new social and family relationships
• Developing social competency/interpersonal effectiveness
• Working within one’s cultural infrastructure
Models of Treatment
• Relapse Prevention
• Adopt strategies designed to help clients
• Become aware of cues or “triggers” that make them more likely to abuse substances or become symptomatic
• Develop alternative coping responses to those cues
Medication Assisted
• Addiction
• Methadone
• Suboxone
• Vivitrol
• Antabuse
• SSRIs
• Mental Health
• SSRIs
• Atypical antipsychotics
Harm Reduction
• Acceptance that drug use and mental health issues are a reality
• Preventing the harm caused by them
• 4 Ls: Liver, Lover, Livelihood, Law
• Interventions
• Low-threshold pharmacological interventions
• Needle exchange programs
• Emphasis on non-injection routes
• Involvement of those with a history of use or distress in program development
Multidisciplinary (Biopsychosocial-Spiritual)
• Psychotherapeutic interventions fro co-occurring issues
• Medication assisted therapy for both addictive and mental health issues
• Wrap around services to ensure people have access to necessary resources to achieve their goals
• Family therapy to improve the interpersonal environment of the person