PUBH 3003 1st Edition Lecture 19Outline of Last Lecture I. A bit about inhalants a. Consequencesb. How they are usedc. Types of inhalants II. In the newsIII. Signs of abuse Outline of Current Lecture:I. Interventiona. Medical Modelb. Methodsc. Out-patient programsII. NIDA principles of drug action treatment III. SAMHSA’s guiding principles of recoveryIV. Strategiesa. Relapse Preventionb. Risk factorsc. TriggersCurrent Lecture:Chemical Dependency Intervention and Treatment Intervention Background- Alcoholics Anonymous- 1935o Medical model- recognizing alcoholism as a diseaseo Christian based spiritual model- alcoholism a manifestation of power of sin, requiring confession- Yale Research group – 1940’s – 1960’s (E.M Jellinek)o Heavily promotes the disease concept of alcoholism o Disease model endorsed by WHO in 1951; AMA in 1956- Research and treatment efforts diverge largely because of agency separation in the federal governmentThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.o Alcohol- National Institute on Alcohol Abuse and Alcoholism (NIAAA)o Other drugs – National Institute on Drug Abuse (NIDA)Benefits to Medical Model- Shifts focus from moral to disease model- Fosters humane treatment - Fosters scientific attention - Fosters improved treatmentMethod of Intervention-Carefrontation, not confrontation -Include all parties-Rehearse -Be descriptive and specific-Commit to a planModel for raising a sensitive issue- I care…. (Describe relationship feelings)- I see…. (Specific, observable behaviors, avoid making a judgment or diagnosis) - I feel…. (How these behaviors affect you)- LISTEN – if he/she gets angry or provokes you, remind yourself to remain calm and focus on your task. Remain factual and non judgmental - I want…. (It may be necessary to set some limits or firm resolution)- I will…. (Indicate your support, what you are willing to do to help, and limitations)Broadening the base of treatment - Communityo Public health screeningo Multiple settingso Brief interventions, may include medicationo Referral to specialized treatment - Specializedo Severe disorders or problemso Prior history of dependence o Comorbidity (liver damage, mental illness)Out-patient Programs - Refers to host of treatment programs that do not involve residential time- Initial strategy may involve detoxification- Treatment strategies vary, depending on resources and philosophy of facilities:o Individual counselingo Group therapyo Family therapyo Vocational trainingo Crisis centers- Tend to be either “change oriented” or “adaptive”o Change oriented- seeks to bring about radical change of lifestyle o Adaptive- seeks to help individual lessen dependence so they can function more effectivelyResidential Program: MN model- Based on two early (1940s) programs in MN – Pioneer House and Hazelden- Built upon principles of AA as the core, with various counseling activities by both professional and non professional staffo Initial detoxificationo Group therapyo Spiritual meditation- Historically 30 days NIDA Principles of drug addiction treatment1) Addiction is a complex but treatable disease that affects brain function and behavior2) No single treatment is appropriate for all individuals3) Treatment needs to be readily available 4) Effective treatment attends to multiple needs of individual, not just his or her drug use5) Remaining in treatment for an adequate period of time is critical for treatment effectiveness6) Behavioral therapies- including individual, family or group counseling – are the most commonly used forms of drug abuse treatment 7) Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies 8) An individual treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the persons changing needs 9) Addicted or drug- abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way10) Medically – assisted detoxification is only the first stage of addiction treatment and by itself does little to change long term drug abuse11) Treatment does not need to be voluntary to be effective12) Drug use during treatment must be monitored continuously, as lapses during treatment to occur13) Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases and counseling to help patients modify or change behaviors that place themselves or others at risk of infection SAMHSA’s 10 guiding principles of recovery1) Recovery emerges from hope2) Recovery is person- driven3) Recovery occurs via many pathways4) Recovery is holistic 5) Recovery is supported by peers and allies 6) Recovery is supported by peers and allies7) Recovery is supported through relationship and social networks8) Recovery is supported by addressing trauma 9) Recovery involves individual, family and community strengths and responsibilities 10) Recovery is based on respectDoes Relapse to drug abuse mean treatment has failed?- Any behavior include setbacks; these setbacks are called “lapses” or “slips”- Two possible outcomes from a lapse:o Relapse: returning to old behavior (follow an initial setback)o Prolapse: getting back on track in the direction of positive change Strategies- Combining treatment medications o Treating withdrawal o Staying in treatmento Preventing relapse - Behavioral therapyo Cognitive behavioral therapyo Motivational interviewing o Group therapy/ family therapyo Contingency management Societal Values and Recovery Values - Societal Valueso You have a right to drinko Mind your own business and be independento Love equals protectiono Let trained people helpo Control is the most important- Recoveryo You have a right to be drug free o Unity give strengtho Tough loveo You help others in order to help yourselfo HarmonyRelapse Prevention- What is relapse prevention?o Cognitive behavioral approach with the goal of identifying and preventing high-risk situations for relapse- History of Relapse Preventiono Drug and AlcoholNatural history of a lapse- Risk factors- Triggers- All- or – noting thinking - Guilt and self blame- Replaying and reviewingRisk Factors- Internal: aspects of one’s physical or mental condition that reduces his motivation or interrupts his