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Terrence D. Walton Terrencewalton@aol.com
Treatment: Doing The Right Thing …In The Right
WayTerrence D Walton, MSW, ICADC
Terrence D. Walton Terrencewalton@aol.com
Terrence D. Walton Terrencewalton@aol.com
Treatment IsTreatment 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
Treatment Must EnhanceTreatment Must Enhance
Motivation – Why change?
Insight – What to change?
Skills – How to change?
Terrence D. Walton Terrencewalton@aol.com
What Works?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
For the BEST OUTCOMES Provide a
Puzzle of Evidence Based Approaches
Cognitive Behavioral
Pharmacological Interventions
Motivational Approaches
Case Management
Continuing Care
Community Reinforcement
Terrence D. Walton Terrencewalton@aol.com
Gender and Cultural Competence
Terrence D. Walton Terrencewalton@aol.com
Family/Community Family/Community InterventionsInterventions
1) Structural-Strategic Family Therapy
2) Multi-Systemic Therapy (MST)
3) Systematic Training for Effective Parenting (STEP)
4) Community Reinforcement Approach (CRA)
Terrence D. Walton Terrencewalton@aol.com
Group InterventionsGroup Interventions
1) Multi-Family Therapy Groups
2) Psychoeducational Groups
3) Self Help Groups
Terrence D. Walton Terrencewalton@aol.com
Individual InterventionsIndividual Interventions
1) Pharmacotherapy/Acunpuncture
2) Cognitive Behavioral
3) Motivational Enhancement Approaches
Terrence D. Walton Terrencewalton@aol.com
Pharmacological InterventionsPharmacological Interventions
Goals – Provide:– relief from withdrawal symptoms *– prevent drugs from working– reduce craving*– aversive reactions
*Acupuncture found effective
Terrence D. Walton Terrencewalton@aol.com
Pharmacological InterventionsPharmacological InterventionsMethadone – 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
Understanding C-B ApproachesUnderstanding 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
Understanding C-B Understanding C-B ApproachesApproaches
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
Three C-B ApproachesThree 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
Reality Therapy: WDEP Reality Therapy: WDEP SystemSystem
W________________
D________________
E________________
P________________
Terrence D. Walton Terrencewalton@aol.com
Direction/DoingDirection/Doing
W________________A________________Y________________D________________
Terrence D. Walton Terrencewalton@aol.com
Motivational ApproachesMotivational Approaches
How People Change
Terrence D. Walton Terrencewalton@aol.com
Why people changeWhy people change
W_______
A_______
R________
Terrence D. Walton Terrencewalton@aol.com
How People ChangeHow People Change
1.Pre-contemplation2.Contemplation 3.Preparation4.Action 5.Maintenance
Terrence D. Walton Terrencewalton@aol.com
Not at all ready to change
Thinking about change
Preparing to change
Actively working on or maintaining a
changePreContem-plation
Contem-plation
Prepar-ation
Action Maintenance
The “Readiness Ruler"
Terrence D. Walton Terrencewalton@aol.com
PRE-CONTEMPLATIONPRE-CONTEMPLATION
Terrence D. Walton Terrencewalton@aol.com
Why people don’t changeWhy people don’t change
RevelingReluctanceRebellionRationalizingResignation
Terrence D. Walton Terrencewalton@aol.com
CONTEMPLATIONCONTEMPLATION
Terrence D. Walton Terrencewalton@aol.com
The Decisional BalanceThe Decisional Balance
1. What do you want that you…
2. What do you want that you…
3. What are you getting that you…
Terrence D. Walton Terrencewalton@aol.com
PREPARATIONPREPARATION
Terrence D. Walton Terrencewalton@aol.com
ACTIONACTION
Terrence D. Walton Terrencewalton@aol.com
MAINTENANCEMAINTENANCE
Terrence D. Walton Terrencewalton@aol.com
Traps to AvoidTraps 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
GENERAL PRINCIPLESGENERAL PRINCIPLES1. Express Empathy2. Develop Discrepancy3. Roll with Resistance4. Support Self-Efficacy
Terrence D. Walton Terrencewalton@aol.com
Express EmpathyExpress Empathy
Acceptance facilitates change
Skillful reflective listening is fundamental
Ambivalence is normal
Terrence D. Walton Terrencewalton@aol.com
Develop DiscrepancyDevelop 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
Roll with ResistanceRoll 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
Support Self-EfficacySupport 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.
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