AnnouncementsExam ThursdayElection today!Evaluation feedbackAssessmentGathering information necessary to conceptualize a person’s situation and to establish a plan for treatmentCollaboratively identify problems, needs, goalsBuild rapport for a professional, therapeutic relationship-Way to talk to an individual, to see what their problems are, what goals might be and work with someone to figure out everything in their live that is relevant to treatment-Make a best guess at what interventions will be best for the patients-Figure out what goals are, and what to work with them on.To do this, physicians should work with the patient in a collaborative way. This means asking where the person wants to be at, what things in life does that person want to see change. It is not the clinician making all of the decisions, it is the client telling the clinician what they want out of treatment and what things they want to change about their life. Clinician’s work with clients to figure out what is best for them.Assessment happens right when you come into a treatment centerFocus of assessment depends on “what you have to offer”Simple interventions (brief intervention)Very brief, closed-ended, targeted assessmentMedical interventions (e.g., medications)Longer assessment, more focused on medical issuesComprehensive psychosocial interventionsLonger, open-ended, broad assessmentMultidimensional assessment, well articulated goals, and treatment planningThe intensity of the assessment you give really depends on what you are intending to offer.The take home message here is depending on the context of the intervention it is going to have certain things that may be uncovered that will let us know if intervention is appropriate or effective.Movie:Interview of Theresa MartinezNo history of depressionShe claims she has insomnia, depression, and fatigueThe interview is more of a specialized of someone who is very aware of substance useWhat was asked before all of these questions?Whether or not she drinks alcohol at risky levels. This put her at a high risk for alcohol use disorder so the physician asked more questions.In the past 12 months the patient:Spent less time on other mattersSpent a lot of time drinkingNot be able to stick to drinking limitsNot been able to cut down or stopKeep drinking despite problemsMaybe shown tolerance?Physician told Teresa he believes she has a drinking dependence; he does not call her an alcoholic.This interview should be more collaborative which would mean the physician should be working with her to develop a plan instead of just telling her what to do.He said, “You need to stop drinking.” This is actually something advised against for clinicians, if they tell people that it could scare them off, maybe people aren’t ready to hear that.A better approach would be to ask her where she wants to see herself. Ask people what their goal would be in terms of reducing their drinking, rather than telling them that they need to quit.Psychosocial AssessmentComprehensive understanding of person’s substance use problems as they have affected multiple facets of his/her lifeStructured questionnaire/interview + non-judgmental discussionPurpose is to inform treatment planning and referralsIt is pretty structured, maybe longer, and asking people questions off of an interviewThey will take notes throughout the interviewYou want to be nodding and validating feelings as the interview progresses. The whole point is trying to figure out what to do with the person.“…patients whose problems are identified at admission; and then receive services that are matched to those problems, stay in treatment longer”Maslow’s Hierarchy of NeedsMorality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts(Self-actualization)Self-esteem, confidence…(Esteem)Friendship, family…(Love/belonging)Security of: body, employment, and resources…(Safety)Breathing, food, water, sex, sleep(Physiological)The Bottom 2 of the pyramid which are safety and physiology are what need to be fulfilled in order to get proper treatment for patients.(This next section is important for the exam)Treatment planningOld way:“One-size fits all” treatment planDriven byWhat is offered by the programProgram philosophyIncorporatesPre-scheduled meetings and groupsPre-packaged, available servicesVariationMost treatment plans within a treatment program look the sameNew way:Individualized treatment planDriven byWhat someone needsIndividuals desire, “person-centered”IncorporatesMeetings and groups as a tool to meet specific needsA range of needed services, within the clinic and/or communityVariationMost treatment plans within a treatment program look differentComponents of a treatment plan1. Problem Statements: What did we uncover in the assessment?2. Goal Statements: What can we reasonably achieve?3. Objectives: What can the individual do to meet the goals?4. Interventions: What specific interventions might help?If we want to get more information about this we can look at the example treatment plan. This is posted online. We are not going over this in class.ReviewSimilar test to the first exam. We don’t need to know chemical formulas, statistics or anything of that measure.Sample question:We talked about entactogenic effects, but also other effects like illusions, delusions, etc.Entactogenic is what?Insight into one’s one mind. The term someone else offered for that is introspection.(Really important to have for the exam)Delusions: think someone is out to get youIllusions: something you are actually seeing that is just alteredHallucinations: seeing something that isn’t thereOld neurocognitive enhancements: Adderall, Ritalin, etc.The new neurocognitive enhancers: memory enhancement and the drug used for that is Donepezil which is a Alzheimer’s medicationWhat is it that people do to create the prescription drug epidemic? What is doctor shopping?Going around to pain clinics or different doctors trying to get a prescriptionDiversion: What do we know about medicine cabinets? Essentially diversion is people are prescribed these pills everywhere, rather than the individual taking them as prescribed they give them to someone else.Know the veterans studyKnow the difference between short and long-term effects:If someone is pregnant and they are using opiates they can become dependent on them and the fetus can become dependent on that drug. The baby is born and experiences withdrawal