Moving Co-Occurring Clients Through the Stages of Change

1. Moving Co-Occurring Clients Through the Stages of Change By Jill S. Perry, MS, NCC, LPC, CAADC, SAP JP Counseling & Associates, LLC 724-494-6750

2. What does COD Look Like? JP CounselingHealing for Adults, Youth and Families

3. JP CounselingHealing for Adults, Youth and Families

4. JP Counseling & Associates, LLCHealing for Adults, Youth and Families

6. Stigma JP Counseling & Associates, LLCHealing for Adults, Youth and Families

8. 5 Rules to Eliminate Stigma • 1) Don’t label people who have a mental illness or addiction • 2) Don’t be afraid of people with mental illness or addiction • 3) Don’t use disrespectful terms for people with mental illness or addiction • 4) Don’t be insensitive or blame people with mental illness or addiction • 5) Be a role model JP Counseling & Associates, LLCHealing for Adults, Youth and Families

9. SAMHSA 2014

10. National Survey on Drug Use & Health 2017 • SUD: 18.7 million adults age 18 and older • COD: 8.5 million How many do you think are in treatment?

11. National Survey on Drug Use & Health 2017 • SUD: 92% not in treatment • COD: 92% not in treatment

12. Statistics of Co-occurring Disorder • When it comes to genders, employed men were twice as likely as employed women to have struggled with substance abuse in the past year (13.2% for men, and only 6.9% for women). • However, employed women were twice as likely to have dealt with serious mental issues in the past year as employed men (14.2% for women, and 7.3% for men). JP Counseling & Associates, LLCHealing for Adults, Youth and Families

13. Statistics of Co-occurring Disorder • More than 50% of people diagnosed with co-occurring disorder did not receive any medical treatment • Out of the 3 million adults who are employed and diagnosed with co-occurring disorder, only 40% received a treatment for either of their disorders • Less than 5% received treatment for both disorders. JP Counseling & Associates, LLCHealing for Adults, Youth and Families

14. In the past, the attitude was that the client with COD was the exception. Today, clinicians should be prepared to demonstrate responsiveness to the requirements clients with COD present. JP CounselingHealing for Adults, Youth and Families

16. Is Change Difficult?

17. What is something YOU want to change?

18. WHY Does Change Occur?

19. Experiences Can Prompt Change • Distress levels • during or following episodes of severe anxiety or depression • Critical life events • Cognitive evaluation • This weighing of the pros and cons of substance use accounts for up to 60% of the changes reported in natural recovery studies

20. Experiences Can Prompt Change • Recognizing negative consequences and the harm or hurt one has inflicted on others or oneself • Positive and negative external incentives • Supportive and empathic friends, • rewards • coercion of various types

21. Changes takes place…. • Over time…most change does not occur overnight • At different points in the life cycle • Involves a sequence of events

22. Changes takes place…. • Change is best viewed as a gradual process with occasional setbacks, much like hiking up a bumpy hill • Difficulties and setbacks can be reframed as learning experiences, not failures

23. What does this sound like?

24. RECOVERY • A personal journey through an intentional change process that is influenced at various points by a host of factors

25. 3 Types of Behavior Change • Creating patterns of behavior • Modifying habitual behavior patterns • Stopping problematic patterns

26. Myths Self-change is simple It just takes willpower I’ve tried everything—nothing works People don’t really change

27. Serenity Prayer Changes we control Changes we can’t control Ability to know the difference

28. Common Natural Changes • Going to college • Getting married • Getting divorced • Changing jobs • Joining the Military • Taking a vacation • Moving • Buying a home • Having a baby • Retirement

29. Natural Changes in SU • Experimenting with substances during high school • Stopping drinking after an automobile accident • Reducing alcohol use after college • Stopping substance use before pregnancy

30. Natural Changes in SU • Decreasing cigarette use after a price increase • Quitting marijuana smoking before looking for employment • Refraining from drinking with certain friends • Reducing consumption following a physician’s advice

31. Models of Addiction/Mental Health • Both-and vs. Either-or • Social/Environmental • Genetic/Physiological • Personality/Intrapsychic • Coping/Social Learning • Conditioning/Reinforcement • Compulsive/Excessive Behavior • Biopsychosocial

32. How Change Occurs No Magic Pill! Apply to any Theory Timing is everything!

33. Old Paradigm Dramatic Spontaneous Unpredictable Program Design *Inefficient *Failure rates

34. Stages of Change Model By Prochaska, Norcross, DiClemente Predictable Controllable Whole process is as important

35. Ch…ch…ch…changes Center for Disease Control National Cancer Institute National Institutes for Alcoholism and Alcohol Abuse American Lung Association Johnson & Johnson National Health Service of Great Britain World Health Organization

36. Ch…ch…ch…changes Delinquent adolescents Substance abuse and addiction Depression Anxiety & Panic Disorders Traumatic Brain Injuries Weight Loss (diet & exercise)

37. Transtheoretical Model (TTM) • Brings together divergent perspectives • Personal pathway to integrate and understand multiple individualized influences • A person’s choices influence and are influenced by both character and social forces • Interaction between the individual and risk and protective factors

38. Problem vs. Preference

39. Motivation • Motivation is a key to change. • Motivation is multidimensional. • Motivation is a dynamic and fluctuating state. • Motivation is interactive. • Motivation can be modified. • The clinician’s style influences client motivation.

40. Benefits of Motivation Enhancement • Inspiring motivation to change • Preparing clients to enter treatment • Engaging and retaining clients in treatment • Increasing participation and involvement • Improving treatment outcomes • Encouraging a rapid return to treatment if symptoms recur

41. Basic Strategies • Focus on the client’s strengths rather than his weaknesses • Respect the client’s autonomy and decisions • Make treatment individualized and client centered • Do not depersonalize the client by using labels like “addict” or “alcoholic”

42. Basic Strategies • Develop a therapeutic partnership. • Use empathy, not authority or power. • Focus on early interventions. Extend motivational approaches into nontraditional settings. • Focus on less intensive treatments. • Recognize that SU & MH disorders exist along a continuum.

43. Basic Strategies • Recognize that many clients have more than one SU or MH d/o. • Recognize that some clients may have other coexisting disorders that affect all stages of the change process. • Accept new treatment goals, which involve interim, incremental, and even temporary steps toward ultimate goals.

44. 4 Dimensions of Change • Stages • Processes • Markers • Context of Change

46. Treatment Tasks • Precontemplation: Increase concern & hope for change • Contemplation: Tip the decisional balance • Preparation: Commitment & effective plan • Action: Problem solving; support self-efficacy • Maintenance: Prevent relapse

47. Quick Assessment I solved my problem more than 6 months ago. I have taken action on my problem within the past 6 months. I am intending to take action in the next month. I am intending to take action in the next 6 months.

48. 10 Processes of Change 1. Consciousness-raising 2. Social Liberation 3. Emotional Arousal 4. Self-reevaluation 5. Commitment 6. Countering 7. Environment Reevaluation 8. Rewards 9. Helping Relationships 10. Stimulus Control

49. How Change Occurs Processes For each process there are hundreds of techniques

50. Markers of Change Decisional Balance: Weighted strongly towards encouragement b/c of potency of rewards, impotency of negatives and increasing alternate rewards Self-efficacy: Possible false sense of self-control and/or sense of hopelessness about the ability to change that justifies status quo