effective treatment: doing the right thing in the right way terrence d walton, msw, icadc
Post on 16-Dec-2015
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Process
Full Continuum of Care
Adequate Duration Sufficient Intensity Stage of Recovery-
based Design Policies & Procedures Team Interactions Evaluation
Practice
Culturally-appropriate evidenced based treatment practices
Practitioners trained and coached in manual-guided delivery
Services dominated by those that have been rigorously tested
• Randomized Controlled Trials• Project MATCH• COMBINE Study• UK Alcohol Treatment Trials• Mesa Grande Project (361
clinical trials analyzed)
Four Big Alcohol Studies
1. Behavioral Couples Therapy (BCT)– Not well tested in an offender population
2. Brief Interventions (5 or fewer sessions)– Not appropriate for an addicted DUI offender
Other Evidence Based Practices
Not Evidence Based
1. Generic Counseling2. AOD Education3. Confrontational
Interventions4. Psychodynamic Therapy5. Solution-focused
Therapy6. Mindfulness-based
Stress Reduction7. Acupuncture
Goals of Cognitive Behavioral Therapy (CBT) Approaches
1. Analyzes thoughts, feelings, and actions (behavior)
2. Thoughts drive emotions
3. Emotions drive behavior
4. Identify thinking patterns and stop thinking “errors” from leading to emotional reactions that produce problem behaviors.
Be Skeptical
• Nearly every evidenced based intervention is manual-based.
• However not every intervention that is manual-based is evidenced based.
1. To increase and maintain the person’s motivation to change his or her life
2. Motivate those who don’t want to change
3. Help increase the motivation of the people who aren’t sure
4. Help the motivated maintain their readiness to change
Motivational Approaches
1. Motivational Interviewing: Preparing People for Change– William Miller & Stephen
Rollnick (2002)
2. Addiction and Change: How Addictions Develop and Addicted People Recover– Carlo C. DiClemente
(2003)
1. To provide relief from withdrawal symptoms
2. To prevent drugs from working (antagonist)
3. To reduce craving
4. To provide replacement (agonist)
5. To provide aversive reactions
Medication-Assisted Treatment
• Naltrexone – Interrupts actions of alcohol and opiates; reduces cravings (Vivitrol)
• Acamprosate – reduction of alcohol cravings
• Disulfiram/Antabuse – produces adverse reaction with alcohol use
Medication-Assisted Treatment
• Methadone – Opiate addiction – reduces craving, mediates withdrawal symptoms, helps restore normal functioning (agonist)
• Buprenorphine (Subuxone) – similar to methadone, may be prescribed by an MD with special training (partial agonist)
Driving while usinga legally prescribed medication,
including methadone taken according to doctor’s orders,
can still trigger a DUI charge in all 50 states
Medication-Assisted Treatment
Combining Medications and Behavioral Interventions for Alcoholism
THE COMBINE
STUDY
• Finding: Naltrexone in combination with medication management sessions delivered by health professionals was at least as effective as psychosocial interventions
• Side note: Pathology of multiple DUI offenders will likely require psychosocial interventions in addition to medications
Those Missed
92.9% with bipolar disorder 68.4% with depression 100.0% with OCD
1. Blended Screening and Assessment Approaches?
2. Education on Co-Occurring Disorders?3. Medication Monitoring and Management
Sessions?4. Heavy Utilization of Positive
Reinforcement and Flexible Application of Graduated Sanctions?
5. Mental Health Specialists?6. Agreements with Community Mental
Health Services Agencies?
Does Program include:
Using Support Groups in Therapy
“The 12 Step Facilitation Therapy Manual”Offer choice (types, spiritual & secular)Be selective regarding approved groupsTry to match demographics, lifestyles, and level of substance involvementwww.smartrecovery.org
1. Identify and adopt evidence-based practices2. Incorporate medication-assisted treatment3. Utilize alcoholics anonymous and provide
secular alternatives for those with religious-based objections
4. Treat the hard, core alcohol-dependent impaired driver
5. Modify (lessen) treatment requirements if treating non-addicted participants in DWI Court.
6. Stay abreast of latest DUI Court treatment-related research findings
Next Steps
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