“From Here to Eternity” Special Issues in Alcohol and other Drug Treatment:

1. <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>0,0,0</gridFillColor><gridOpacity>100%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Blue</insertObjectUsingColor><showResults>Yes</showResults><teamColors>User Defined</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>Slides with Get Feedback Objects</showControlBar><defaultCorrectPointValue>100</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName><AutoRec></AutoRec><AutoRecTimeIntrvl></AutoRecTimeIntrvl><chartVotesView>Percentage</chartVotesView><chartLabelsColor>0,0,0</chartLabelsColor><isChartLabelColorKnownColor>True</isChartLabelColorKnownColor><chartLabelColorName>Black</chartLabelColorName><chartXAxisLabelType>Full Text</chartXAxisLabelType></Settings> <?xml version="1.0"?><AllAnswers /> “From Here to Eternity” Special Issues in Alcohol and other Drug Treatment: Part 1: Addiction, Recovery & Relapse Part 2: Treating Co-Occurring Disorders in Youth Terrence D. Walton, MSW, CSAC Director of Treatment District of Columbia Pretrial Services Agency

2. Part 1: Addiction, Recovery, & Relapse

4. Contributing Factors for Abuse & Dependence • Biological predisposition • Childhood experiences; modeling; neglect & abuse; detachment; excessive stress; shame

5. Contributing Factors for Abuse & Dependence • Culture; social norms; beliefs & values • Lack of socio economic barriers • Underlying mood, anxiety or personality disorders; Post traumatic stress disorder (PTSD) • Pharmacology

6. How Do Drugs Work?

7. Mood Altering Chemicals • Legal & Illicit • Street Drugs and Prescribed Drugs • Hard Drugs & Soft Drugs • Very Addictive & Less-Addictive • Natural and Synthetic • Stimulants • Depressants • Opioids • Cannabinols • Hallucinogens/ Dissociatives • Inhalants/ Deliriants/Other

8. Getting the Intended Effect • Bottle to Blood to Brain • Route of Administration: • Smoke • Sniff • Snort • Shoot • Swallow • The Blood Brain Barrier • Neuro-compatibility

9. Neurons & Neurotransmitters

10. Treatment That Works

11. Five Essential Action Steps • Get Ready (preparatory) • Break Free • Break the Connection • Choose the Right Path • Deal with Temptation

12. Getting Ready • Self-assess change readiness • Determine if change is warranted • Resolve ambivalence about change • Become committed to change

13. Breaking Free • Breaking the cycle of compulsive use (e.g. detoxification, residential, jail, contracting, accountability, force of will) • Cutting the ties to & reminders of addiction across all life situations • Begins on the first day of the attempt to quit or modify the behavior • Acting on the commitment to change (e.g. quit date) • 3 to 6 months

14. Readiness to Change Pre-Contemplation Contemplation Preparation Action Maintenance

15. Breaking the Connection • Stimulus Generalization(addiction) • Stimulus Control (avoiding the cue/stimulus or simply refusing to respond to the cue/stimulus) • Counter Conditioning (changing the response to the cue/stimulus; new skills; replacement behaviors) • Reinforcement(essential to compete with the immediate reward of drug use)

16. Choosing the Right Path • Out of Addiction (treatment, church, support groups, will power) • Of Treatment (treatment options) • Throughout Recovery • Choices made daily and moment by moment • Constantly aware of which path I’m on • Activating recovery-oriented neural pathways

17. Dealing with Temptation • Break the connection between temptation and use • As temptations persist and intensify, self-efficacy and confidence decline • As temptations decrease, self-efficacy and confidence increase • As self-efficacy and confidence increase, temptations may either decrease or increase

18. How Do People Recover And Stay Recovered?

19. Defining Recovery In conjunction with a day-by-day commitment to remain abstinent, the ongoing process of overcoming physical and psychological dependence on mood altering chemicals and learning to live in a state of total abstinence, without the need for those substances. In recovery, the individual relies on healthy, constructive activities and experiences for happiness and fulfillment.

20. Recovery Model Sobriety

21. Defining Relapse When a person in recovery returns to the self-prescribed, non-medical use of any mood altering chemical (MAC) and the risk of the problems associated with that use The return to use after a period of abstinence that interrupts the addicts ongoing attempts to recover A return to drug use that is precipitated by and/or leads to thelessening of commitment to recover

22. Big Question Is it “relapse” or “continued use”?

23. Research • Recent studies demonstrate relapse rates of 40% to 60% at one year follow-up • Most relapses occur in the first year of recovery, with two thirds occurring in the first 90 days • Clients who remain in treatment the longest generally have the best outcomes

24. Relapse An unfolding process in which the resumption of substance abuse is the last event in a long series of maladaptive responses to internal or external stressors or stimuli

25. WHAT IS RELAPSE PREVENTION? Therapy designed to teach people to recognize, anticipate, and manage the relapse warning signs so that they can interrupt the relapse process early and return to the process of recovery.

26. Relapse Prevention Planning • Written, specific, and rehearsed plans • Reiterates commitment to and rationale for recovery • Outlines and schedules recovery supportive activities • Identifies warning signs, cues, and high risk situations (triggers) • Details preventive and progressive responses to all triggers

27. Responding to and Recovering from Relapse

28. Responding to Relapse • Analysis • Assessment • Assistance • Accountability • Assurance

29. Part 2: Co-Occurring Disorders in the Young

31. Substance-Related Health Continuum Wellness Illicit Use Problematic Use Abuse Dependence

32. About Abuse A pattern of use of any substance for mood or perception altering purposes that causes recurrent problems in major life areas

33. About Addiction Substance use that has an appetitive nature, has a compulsive and repetitive quality, is self-destructive, and is experienced as difficult to modify or stop

34. Mental Health Continuum Wellness MH Problems Common MH Problems Disorders Serious Emotional Disturbance

35. Serious Mental Health Problems in Youth • Axis I Disorders • Serious Emotional Disturbance • Developmental Disorders • Axis II Disorders • Personality Disorders • Mental Retardation

36. Serious Emotional Disturbance Diagnosable disorders in children and adolescents that severely disrupt their daily functioning in the home, school, or community. These disorders include depression, attention-deficit/hyperactivity, anxiety disorders, conduct disorder, eating disorders (and others)

37. Axis I Disorders • Includes every mental diagnosis except the personality disorders and mental retardation • Symptoms are often severe and disabling if untreated • Often can be treated with psychotropic medication in combination with psychotherapy (except developmental disorders)

38. Examples of Axis I Disorders • Attention Deficit Disorder • Disruptive Disorders • Conduct Disorder • Oppositional Defiant Disorder • Child or Adolescent Antisocial Behavior • Disruptive Behavior NOS

39. Examples of Axis I Disorders • Anxiety Disorders • Panic Disorders • Phobias • Obsessive Compulsive Disorder (OCD) • Post Traumatic Stress Disorder (PTSD) • Mood disorders • Major Depressive Disorder • Dysthymic Disorder • Bipolar Disorder

40. Examples of Axis I Disorders • Psychotic Disorders • Schizophrenia • Schizoaffective Disorder • Mood Disorder with Psychosis • Pervasive Developmental Disorders • Autism • Asperger’s Disorder • Rett’s Disorder • Childhood Disintegrative Disorder

42. Mental Retardation (Axis II) Significantly below average general intelligence functioning accompanied by significant limitations in adaptive functioning in major skill areas. Onset must occur before age 18.

43. Less likely to be capable of benefiting from cognitive-based, insight oriented treatment interventions • More likely to be victimized in drug using, criminally involved peer groups

44. Co-Occurring Disorder Continuum Abuse MH Disorder Addiction SED

45. Prevalence • Prescription drugs are the 2nd most commonly abused drugs—behind only marijuana (ONDCP 2007). • 20.6% of U.S. population over 12 reports misuse of a psychotropics (NSDUH 2009) • 7 million report currently misusing (SAMHSA 2010) • ER visits for opiate misuse doubled from 2004 to 2008 (CDCP 2010) • Those under 18 are among the fastest growing group misusing

46. Commonly Abused Drugs by Youth • Alcohol • Marijuana • Inhalants • Ritalin • Benzodiazepines • Other prescription meds

47. A Lifetime of Self Medicating

48. Pain Discomfort Heroin Opiates Pain Relieving Distracting

49. Numb Empty Bored Cocaine Meth Ecstasy Risk, Stimulation, Adrenaline

50. Anxious Stimulated Hyper THC Alcohol Self Soothing Behaviors