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Background
“Where the scientist is searching for empirical truth, the alcoholic and addict are searching for a workable answer to their painful entrapment. The objectivity and detachment of the scientist stand in stark contrast to the passionate belief and commitment that marks most avenues of recovery”. Bill White
Possibilities
Addiction is a primary disease
Addiction is the result of psychiatric, social, or other conditions
Both are true
Neither is true
It depends
I don’t know, it is a mess!
Treatment Activities
Self-Reflection
Prayer and Meditation
Relationships with Others (Counselor, Group, Peers, Family, Mentors)
Insight & Confrontation
Education & Skill Development
Experiential (Psychodrama, Recreation)
Questions
What is treatment?
What is the most important aspect or aspects of treatment?
How do we know if treatment is successful?
The Conundrum
Our paradigm, or how we view addiction and treatment, modifies our perception of treatment itself including the role of the counselor, client, and group. The treatment process, preferred outcomes, and activities are determined by our perception of the problem or solution. Consequently real progress and innovation often requires a shift in our own paradigm.
Evaluation of Models
Who is the proponent?
What are the goals?
What is the rationale?
What is the agent of change?
Evaluation of Models
Who is responsible for the services? Who has the skills and resources?Who determines reality?
Client Others
Dual Disorders Recovery
Dennis DaleyIntegrated approach for clients with addiction and psychiatric disorders.Clients will go through a series of phases in treatment engagement early recovery middle recovery maintenance
Dual Disorders Recovery
GoalsAchieve and maintain abstinenceStabilize acute psychiatric symptoms Improve physical, emotional, social, family,
interpersonal., occupational, academic, spiritual, financial, & legal functioning
Make positive lifestyle changesEarly intervention in relapse to either
Dual Disorders Recovery
Change AgentPatient-counselor relationship, community
support system including the team relationship (counselor, psychiatrist, psychologist, nurse, case manager, family therapist)
Appropriate medication
Relapse Prevention (CENAPS)
Terry Gorski
An applied cognitive-behavioral approach
Disease Model/ Abstinence Based
Relapse Prevention
GoalsAssess global lifestyle patternsConstruct personalized list of early warning
signsWarning sign management strategiesStructured recovery programRelapse early intervention plan.
Relapse Prevention
Rationale Integrates the disease model of chemical
dependency and abstinence-based counseling with cognitive and social therapies.
Agent of ChangeA structured clinical protocol in a process-
oriented interaction among clients, group, and therapist
Living In Balance
Hoffman, Jones, Caudill, Mayo, & Mack
Practical, group-oriented treatment sessions based on cognitive and experiential approaches including daily relaxation and visualization.
Living In Balance
Goals Consistent content and scope of treatment
issuesProvide information about treatment and
recoverySkills for recovery and relapse preventionPractical living skillsOpen confrontation
Living in Balance
Rationale Persons addicted to drugs and alcohol develop an
imbalance in major life functioning. A broad and holistic approach is necessary to restore balance.
Agent of Change Interaction among counselor, group, and group
members as well as intrapersonal responsibility for visualization, meditation etc.
Addiction Counseling
Delinda Mercer
Addresses the symptoms of drug addiction and related areas of impaired functioning and the content and structure of a recovery program. Focuses on behavioral change and participation in 12-step recovery
Addiction Counseling
Goals1. Assist client in maintaining abstinence
2. Assist client in recovering from the damage addiction has caused in client’s life
Addiction Counseling
Rationale Addiction counseling works by helping clients
recognize the existence of a problem and associated irrational thinking. The approach encourages recovery and abstinence by developing psychosocial skills and spiritual development
Agent of Change Client responsibility and support from others
Solution Focused/Brief Therapy
Scott Miller
Designed to assist clients to engage their own unique resources and strengths to solve problems that they bring to treatment.
Solution Focused/Brief Therapy
Goals Focused on client rather than therapist or program Small rather than large Described in specific, concrete, and behavioral
terms Described in situational rather than psychological
terms Stated in interactional and interpersonal terms
Solution Focused/Brief Therapy
RationalThe approach proposes that the solution to
the problem may have little or no relationship with the problem. The number of approaches to any problem is limitless
Agent of ChangeChange is constant and inevitable. The
counselors role is to tap into and utilize existing changes and solutions.
Motivational Enhancement Therapy
William Miller
Seeks to evoke from clients their own motivation to change and consolidate a personal decision and plan for change.
Motivational Enhancement Therapy
Rationale Intrinsic motivation is a necessary and
often sufficient factor in instigating change. No advise or skill training is offered.
Agent of Changeclient
Twelve Step Facilitation
Joseph NowinskiA brief, structured, and manual-driven
approach to facilitating early recovery. The approach is directly based on the principles of AA and NA.
Twelve Step Facilitation
GoalsFacilitate an acceptance of the for
abstinence (surrender)Establish a willingness to participate in
actively in 12-step recovery fellowships
Twelve Step Facilitation
RationaleWillpower alone is not sufficient to sustain
recovery and long-term recovery consists of spiritual renewal
Agent of ChangeActive participation in 12-step fellowship
Minnesota Model
Patricia Owen
Based on a thorough and on-going assessment of the client and a multi-modality approach to services. A multi-disciplinary team develops the treatment program and plan to provide tools and incorporate a 12-step recovery program.
Minnesota Model
RationaleChanging a client’s beliefs about his or
herself occurs as a result of meetings, self-reflection, and learning new coping skills.
Agent of ChangeGroup affiliation12 steps
Psychotherapeutic/ Skills Training
Arnold Washington
Combines psychotherapeutic techniques with abstinence-based counseling. Combines cognitive behavioral, motivational, and insight-oriented techniques.
Psychotherapeutic/ Skills Training
GoalsEnhance the clients motivation for changeTeach the client how to break the addictive
cycleTeach coping and problem-solving skillsSupport and guide the client through
trouble spots and setbacks
Psychotherapeutic/ Skills Training
RationaleAddiction is a multi-determined addictive
behavior and maladaptive (self medication) coping style with biological, psychological, and social components.
Agent of ChangeA therapeutic alliance between client and
counselor
ASSIGNMENT
What activities or types of services are used with this approach?
What types of clients is this approach especially suited to – what types of clients is it not suited to?
Other things of interest about this approach.