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Treatment: Doing The Right Thing …In The Right Way Terrence D Walton, MSW, ICADC

Treatment: Doing The Right Thing …In The Right Way Terrence D Walton, MSW, ICADC. What is Addiction?. Treatment Is …. Organized, professional helping A professional relationship Based on theory and protocol Governed by legal, professional and ethical standards. Treatment Must Enhance.

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Treatment: Doing The Right Thing …In The Right Way Terrence D Walton, MSW, ICADC

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  1. Treatment: Doing The Right Thing …In The Right Way Terrence D Walton, MSW, ICADC Terrence D. Walton Terrencewalton@aol.com

  2. What is Addiction? Terrence D. Walton Terrencewalton@aol.com

  3. Treatment Is… • Organized, professional helping • A professional relationship • Based on theory and protocol • Governed by legal, professional and ethical standards Terrence D. Walton Terrencewalton@aol.com

  4. Treatment Must Enhance • Motivation – Why change? • Insight – What to change? • Skills – How to change? Terrence D. Walton Terrencewalton@aol.com

  5. What Works? Treatment outcome research reveals a number of effective treatment approaches or types to consider Family Group Individual Terrence D. Walton Terrencewalton@aol.com

  6. Cognitive Behavioral Pharmacological Interventions For the BEST OUTCOMES Provide a Puzzle of Evidence Based Approaches Motivational Approaches Community Reinforcement Continuing Care Case Management Terrence D. Walton Terrencewalton@aol.com

  7. Gender and Cultural Competence Terrence D. Walton Terrencewalton@aol.com

  8. Family/Community Interventions • Structural-Strategic Family Therapy • Multi-Systemic Therapy (MST) • Systematic Training for Effective Parenting (STEP) • Community Reinforcement Approach (CRA) Terrence D. Walton Terrencewalton@aol.com

  9. Group Interventions • Multi-Family Therapy Groups • Psychoeducational Groups • Self Help Groups Terrence D. Walton Terrencewalton@aol.com

  10. Individual Interventions • Pharmacotherapy/Acunpuncture • Cognitive Behavioral • Motivational Enhancement Approaches Terrence D. Walton Terrencewalton@aol.com

  11. Pharmacological Interventions Goals – Provide: • relief from withdrawal symptoms * • prevent drugs from working • reduce craving* • aversive reactions *Acupuncture found effective Terrence D. Walton Terrencewalton@aol.com

  12. Pharmacological Interventions Methadone – Opiate addiction – reduces craving, mediates withdrawal symptoms, Buprenorphine – similar to methadone, may be prescribed by an MD with special training Antabuse – produces adverse reaction with alcohol use Naltrexone – stops opiates from working, changes alcohol action for some – reduction in relapse Baclofen – possible reduction in cocaine cravings Terrence D. Walton Terrencewalton@aol.com

  13. Understanding C-B Approaches • Cognitions affect: other cognitions, emotions, and behavior. • Cognitions lead to behavioral changes. • Cognitions play a major role in the development and maintenance of addiction and criminality. Terrence D. Walton Terrencewalton@aol.com

  14. Understanding C-B Approaches • Behavior is developed and maintained by external events (cues or reinforcement) and by internal processes (cognitions) • De-emphasizes early child hood experiences and emphasizes the here and now • Social learning (How a person came to think as he or she does) Terrence D. Walton Terrencewalton@aol.com

  15. Three C-B Approaches • Cognitive Restructuring Models (e.g. criminal thinking models) • Coping Skills Models (e.g. stress management models) • Problem Solving Models Terrence D. Walton Terrencewalton@aol.com

  16. Reality Therapy: WDEP System • W________________ • D________________ • E________________ • P________________ Terrence D. Walton Terrencewalton@aol.com

  17. Direction/Doing W________________ A________________ Y________________ D________________ Terrence D. Walton Terrencewalton@aol.com

  18. Motivational Approaches How People Change Terrence D. Walton Terrencewalton@aol.com

  19. Why people change • W_______ • A_______ • R________ Terrence D. Walton Terrencewalton@aol.com

  20. How People Change • Pre-contemplation • Contemplation • Preparation • Action • Maintenance Terrence D. Walton Terrencewalton@aol.com

  21. The “Readiness Ruler" Not at all ready to change Thinking about change Preparing to change Actively working on or maintaining a change PreContem- plation Contem- plation Prepar- ation Maintenance Action Terrence D. Walton Terrencewalton@aol.com

  22. PRE-CONTEMPLATION Terrence D. Walton Terrencewalton@aol.com

  23. Why people don’t change • Reveling • Reluctance • Rebellion • Rationalizing • Resignation Terrence D. Walton Terrencewalton@aol.com

  24. CONTEMPLATION Terrence D. Walton Terrencewalton@aol.com

  25. The Decisional Balance • What do you want that you… • What do you want that you… • What are you getting that you… Terrence D. Walton Terrencewalton@aol.com

  26. PREPARATION Terrence D. Walton Terrencewalton@aol.com

  27. ACTION Terrence D. Walton Terrencewalton@aol.com

  28. MAINTENANCE Terrence D. Walton Terrencewalton@aol.com

  29. Traps to Avoid • Question – Answer • (“the interrogation”) • Taking Sides (arguing for change) • Expert Trap • Labeling Trap • Premature Focus • Blaming Trap Terrence D. Walton Terrencewalton@aol.com

  30. GENERAL PRINCIPLES • Express Empathy • Develop Discrepancy • Roll with Resistance • Support Self-Efficacy Terrence D. Walton Terrencewalton@aol.com

  31. Express Empathy • Acceptance facilitates change • Skillful reflective listening is fundamental • Ambivalence is normal Terrence D. Walton Terrencewalton@aol.com

  32. Develop Discrepancy • The client, rather than the officer should present the arguments for change. • Change is motivated by a perceived discrepancy between present behavior and important personal goals or values. Terrence D. Walton Terrencewalton@aol.com

  33. Roll with Resistance • Avoid arguing for change. • Resistance is not directly opposed. • New perspectives are invited, but not imposed. • The client is the primary resource in finding answers and solutions. • Resistance is a signal to respond differently. Terrence D. Walton Terrencewalton@aol.com

  34. Support Self-Efficacy • A person’s belief in the possibility of change is an important motivator. • The client, not the officer, is responsible for choosing and carrying out change. • The officer’s own belief in the person’s ability to change becomes a self-fulfilling prophecy. Terrence D. Walton Terrencewalton@aol.com

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