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Last Half of Semester Notes

by: Alii

Last Half of Semester Notes SOW 4700

UWF - Pensacola
GPA 3.66

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Half a semesters worth of notes. Includes notes from the readings. Notes go up to what is on the final. Chapters 8-12
Substance Abuse
Dr. Brown
UWF, Substance Abuse, Social Work, final
75 ?




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This 18 page Bundle was uploaded by Alii on Saturday November 28, 2015. The Bundle belongs to SOW 4700 at University of West Florida - Pensacola taught by Dr. Brown in Fall 2015. Since its upload, it has received 28 views. For similar materials see Substance Abuse in Social Work at University of West Florida - Pensacola.

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Date Created: 11/28/15
Chapter 8­ Motivation and Change.  Change. o When will individuals change?  Individuals will change after hitting rock bottom.  Reaching the point where the consequences of drug use are so bad  that the individual decides to do something about it. o Consequences have become demeaning, shameful, and  foreign to their perception of themselves.  Because the negative cycles and negative consequences have gone on for  too long.  They are sick and tired of feeling sick and tired.  Others will influence them directly or indirectly.  Can see the need for change and support it.  One motivates one person to change may be different for another.  Ex: job is in jeopardy, been touched by someone they love. o May be gradual or can seem abrupt.  Gradual change can motivate exploration of healthy change.  Sudden change aka quantum change.  Has key elements. o Vivid.  Identifiable, distinctive experiences of when the  transformation occurred. o Surprising. o Benevolent.  Living kindness. o Enduring.  A permanent transformation. o Involves conflict.  A rupture in the knowing context.  Outcome of change is the same, no matter how long it took.  Personal transformation. o Resistance is natural  Change brings discomfort and dysphoria.  There are various defense mechanism to avoid taking action.  Denial. o Most common. o Are in denial to the true dimensions of their abuse. o They are in delusion about the consequences and negative  impacts they have. o They rationalize to maintain the delusion. o Change involves the painful acceptance of denials and  delusions.  Minimization. o Used to maintain self­esteem. o Ex: my drinking never has an impact on my children.  Projection. o Important protective functions. o May cover deeper disturbances.  Rationalization. o Clever ideas to avoid responsibilities and maintain frozen  feelings.  Compliance. o Hidden form of resistance.  Conflict avoidance. o Problems handling feelings of anger and disappointment. o Need to be liked and approved.  Obsessive focusing. o May be overly self­critical or critical of others. o Perfectionist.  Acting out. o Lacks awareness of feelings, impulses communicated by  behavior. o Most provocative of defenses. o Mindful acceptance.  Change is describe as a mindful surrender.  Only when we truly let go can things change.  Admitting you have a problem is the first step. o Procrastination is the number one reason people won’t implement change.  Six styles.  The perfectionist. o Waits for the perfect time and situation to take action.  The dreamer. o Unrealistic expectations.  The worrier. o Comes up with fearful reasons for not taking action.  The defier. o Doesn’t follow good advice and rejects help.  Crisis­maker.  Overdoer. o Will focus on one part of the problem to ignore others. o Exertion.  An essential element of change.  Overcoming obstacles to change requires effort, commitment, and  perseverance.  Choice making. o Family of origin.  Must look at issues.  Second­order change. o A cognitive­behavioral technique to change the way one traditionally responds to  situations. o First­order interactions.  Interactions that are mechanical, automatic, and rhetorical. o Second­order change.  The new responses and new interactions.  Motivational interviewing. o A form of intervention meant for people resistant to traditional intervention  methods. o Recognize that motivation may fluctuate depending on the time, situation, and  circumstances. o Helps clients explore and resolve their ambivalence about change. o Has six stages.  Precomtemplative.  Person is not considering change.  Will not admit problems.  Contemplation.  Are considering change, but not sure about it.  Preparation.  Individual decides to do something.  Action.  There has been recent change or an implemented plan of change.  Maintenance.  Involves a commitment to long­term change.  Relapse prevention.  Explores strategies to not return to earlier stages. o Client centered motivational interviewing.  Focuses on eliciting and understanding the client’s view.  People voluntarily choose treatment for themselves. o OARS  Open­ended questions.  Ask open­ended questions.  Affirmation.  Show affirmation for client to build self­esteem.  Reflecting.  Reflect back what client said by asking questions expanding on it.  Summarizing.  Summarizes what client said back to show you are listening. o Effective strategies.  Give advice.  Should clearly identify the problem, explain why change is  important, and advocate specific change.  Remove barriers.  Address blocks to change.  Provide choice.  Don’t tell them what to do.  Decrease desirability.  Weight the pros and cons of change against continuing the  behavior.  Practice empathy.  Understand one’s meaning through reflective listening.  Provide feedback.  Clarify goals.  Restate goals in a realistic and attainable manner.  Help active.  Express actively and affirmatively your interest in your client’s  progress. o Is a nondirective approach. o Effective brief counseling.  FRAMES.  Feedback.  Responsibility. o Stress who is responsible for change.  Advice.  Menu. o A list of choices. o Offer more than one choice.  Empathy. o Not sympathy.  Self­efficacy. o Ex: you can do it.  5 general principles of motivational interviewing.  Express empathy.  Develop discrepancy. o Client should present arguments for change.  Avoid argumentation. o Are counterproductive.  Roll with resistance. o Use instead or having tireless debates that only cause more  resistance.  Support self­efficacy. Chapter 9­ Intervention.  Everything one does to create awareness of a drug problem. o Just a slight observation is an intervention.  Can be a conversation expressing concern or a formal intervention.  Any action taken by someone to interrupt the progression of problems. o Can be helping someone from further developing a problem.  Intervention at various stages. o Intervention can prevent progression to the next damaging stage of abuse. o Goal is to let person know there is concern about them. o The earlier the intervention the better to avoid negative consequences.  Later stages of abuse require more effort.  Like a formal intervention. o Stage 1.  Nonuse interventions.  Support to maintain nonuse. o Stage 2.  Initial contact intervention.  Common problem is overreacting or underreacting.  Don’t want to ignore, but don’t want to overreact.  Talk to the child without being judgmental.  Express concerns. o Stage 3.  Experimentation interventions.  Provide information about risk factors and addiction. o Stage 4.  Interventions at the integrated stage.  Communicate concerns and negative consequences.  Point out denial. o Stage 5 and 6.  Interventions at the excessive use and addiction stages.  The longer and more pervasive the problem the more difficult and intense  the level of intervention.  Regular assessment of use.  Outpatient counseling.  Inpatient treatment.  Formal intervention.  Intervention services. o Is a point that prevents, alters, or interrupts to progression of the disease. o Due to denial a trained interventionist may be needed. o Intervention an only work if people maintaining a caring, behavior­specific  approach.  Goals of intervention. o Primary goal is to get the addicted person to recognize they have a problem and  need appropriate treatment. o Secondary goals:  Provide an opportunity for those who care to express concern about the  impact their behavior is having.  Provide information.  Promote the development of a healthy family system.  Family intervention. o Family members will go on with recovery.  Begun the process of change.  Whether or not the abuser goes on with treatment.  Candidates for intervention. o Interventions on adolescents is normally ineffective.  They often feel violated. o Person who values and respects members of the intervention group are the best  candidates.  Stages of formal intervention. o Assessment.  Intervention is staged because family and friends recognize they need to  do something.  Normally after having approached the addict numerous times. o Addict chose not to recognize problem.  Contact interventionist to see if an intervention is appropriate.  Must see if person really does have a problem.  Need behavior­specific information, o Not hearsay or general information. o Needs specific times, dates, etc.  Must assess if addict will listen and understand. o Do not want to have an intervention if person will be  violent.  Many people see intervention as their last effort.  Need to keep planning a secret from addict. o Preintervention.  Develop a group of people.  Interventionist educates the people in it.  Role­play what may happen.  Plan the details of the intervention.  When where, who will sit where, etc. o Intervention.  Each is unique but has common steps for success.  Nonjudgmental tone and behavior­specific caring responses.  Having the addict agree to listen and not talk back.  Bottom­line script is used if addict will not get help.  Must be willing to follow through with the bottom­lines they are  giving. o Postintervention.  Family and friends should meet with the interventionist again before  month long treatment finishes.  They can reflect on the commitments to the intervention and enabling  behavior that used. Chapter 10­ Prevention of Substance Abuse Problems.  Prevention has shifted from scare tactics to emphasizing the worth of people and coping  skills needed to avoid destructive paths.  Goal of prevention is to develop active, involved, empowered, and capable people.  Early prevention approaches. o Early efforts focused on providing:  Information on the dangers of specific drugs.  Warning of physical, social, and psychological harm.  Punishment. o Scare tactics are ineffective.  Information was invalid, exaggerate, and overgeneralized  People questioned credibility. o Converting programs focused on:  Directing.  Teachers tell students what they must believe, value, and do.  Preaching.  Convincing.  Appealed to logic.  Scaring.  Emphasizing the dangers of drug use. o Adolescence did not like being told what to do instead of being talked with.  Wanted communication and open discussion. o Drug­specific approaches.  New prevention strategy that provided factual information.  Emphasized each drug and its pharmacological properties.  Assumed people would make responsible decisions if they knew negative  effects.  Heightened curiosity. o Found the majority of school­based education programs were ineffective.  Only show improvement in knowledge.  Doesn’t change attitudes or use. o Primary prevention.  A constructive process to promote personal and social growth to the  person’s full potential.  Has 3 themes.  Must be understood as the development and reinforcement of  positive behaviors.  Must be responsive in design and operation of those they are  intended to serve or support.  Use a collaborative effort to utilize the already available capacities  and resources of existing human service.  Was a major shift from drugs to the young people.  And pharmacological effects to healthy children. o There are 3 major goals for prevention activities.  Reducing the percentage of use of the gateway drugs.  Tobacco, alcohol, and marijuana.  Reducing destructive behavior.  Retraining the attitudes about substances.  Raising awareness of the addictive nature of drugs.  Alternative activities as a prevention approach. o Teaches people they are able to alter the consciousness in a meaningful, long­ lasting, life­enhancing, and satisfying way without drugs. o Are activities pursued by the individual.  People are encouraged to find activities they enjoy.  Gives ability to get high naturally through one’s own interest.  Is empowering. o Drugs are a passive activity.  Participants sit back and wait.  In active activities they require effort and commitment. o Are acceptable, attractive, and attainable. o Must be realistic and meaningful. o Must help people understand themselves and improve their self­image. o Characteristics  of positive alternatives:  Must contribute to identity and independence.  Offer active participation and involvement.  Must offer a change from commitment.  Must prove a feeling of identification with a larger body of experience. o Use mentors and role models. o Integrate self­concepts.  Need to integrate person’s motives.  Prevention approaches in the 1980s. o Strategy shifted from drugs to people. o Emphasized:  Educational information.  Coping skills.  Personal competence.  Decision making.  Refusal skills.  Alternative activities. o Focus was to understand the impact of drugs on people instead of the  pharmacological properties. o Adolescence in secondary schools (12+) needed intervention, skill building, and  treatment related approaches. th o Shifted primary education to kids in kindergarten­6  grade. o There were 3 kinds of prevention.  Primary.  Assumes person has never tried drugs.  Builds positive self­esteem to develop good coping and refusal  skills.  Provides information on drugs.  Secondary.  Assumes person is in early stages of use, but does not regularly  use.  Provide drug information to stop use.  Improves family communication.  Tertiary.  Assumes person is regularly using drugs but has not become  habitual.  Includes counseling, drug education, and family therapy.  Find line between tertiary prevention and intervention/treatment.  School based prevention curricula. o There are 4 dimensions of prevention.  Course content centering on mental health, drug information, human  development.  Courses on values clarification, problem­solving, and decision­making.  Courses on relationships, personal autonomy, self­esteem, and identity.  Courses on general knowledge. o Empowerment.  Many programs emphasize empowering people.  Basic goal is to empower people and prevent destructive path.  Can say no when one wants, establish a sense of self, etc.  Targeted at the general school, not just high­risk students. o Goal setting.  Includes lessons on:  Setting foals, ranking priorities, making decisions in relation to  gals, persevering during difficult times, and maintaining  motivation. o Capability development.  Key components of prevention programs. o Address community needs. o Include youth in prevention planning.  Include their needs. o Promote proactivity.  Move people from being passive to active.  Involves taking initiative. o Develop a long­term perspective.  Prevention is a long­term strategy.  Programs aimed at high­risk youth. o Require a more intensive and modified program. o Resist traditional authority. o It is too late for refusal skills. o School­based program may be interpersonal problem solving.  Focuses on effective problem solving and interpersonal skills.  Resiliency. o An internal protective factor and the ability to bounce back. o Is about uncovering strength. o Is not getting stuck in the damage model.  Individual is seen as helpful, passive, and trapped. o Need to help person understand the damage, express the anger, grieve the past,  and move on. o Involves making a plan.  May be a getaway plan to create distance from unhealthy situations. o There a 7 factors:  Insight, independence, relationships, initiative, creativity, humor, and  morality.  Domains of prevention. o Families are the primary approach.  Prevention programs and emphasis. o Developmental assets model.  List assets children need to be responsible, successful, and caring.  Average student only experiences 18 of the 40 assets.  Prevention and special populations. o People of color and other minorities.  Have more unemployment, lower level jobs, and poverty.  Experience more frustration, anger, and powerlessness  Prevention must go beyond normal approached.  Must be community based. o College students.  There is a dramatic increase in drug using during the first year of college. o Older adults.  Lack of true role leads to boredom and loneliness.  Prevention is to teach them or someone else to monitor their medication.  Need to be approached with individuality and dignity.  Need to have promotion of healthy activities. Chapter 11­ Disorders Co­occurring with Substance Abuse.  Dual disorders. o Disorders co­occurring with substance abuse. o Include both affective (feeling) and personality disorders.  Normally depression, bipolar disorder, narcissistic, and borderline  personality disorder.  Dual disorders/comorbid disorders/co­occurring disorders. o Used interchangeably. o Describe the condition of having both a psychiatric diagnoses and a chemical  dependency diagnoses.  Symptoms produced by both can overlap. o Most people live between a chemical disorder and psychiatric disorder.  Evaluations take into account the position of the continuum. o Substance abuse in the psychiatric population is 40­60%. o 53% of drug abusers and 39% of alcohol abusers have some mental illness. o 29% of mental ill have some substance abuse. o Possibly the same genetic traits that predisposes people to mental illness may be  the same or similar traits that predispose to chemical dependency.  Serious mental illness (SMI) and substance abuse. o 33.2 million adults aged 18+ have an SMI.  4 million had SMI and substance abuse.  Are very challenging and require more effort to organize.  Only 12% received treatment for both mental health and substance  abuse. o 34% for only mental health, 2% for only substance abuse.  54% received no treatment at all.  Affective disorder and substance abuse. o The difference between depressive mood and a depressive disorder.  When feelings of sadness persist beyond the common period of time. o There are different types and subtypes of depression.  What differentiates them?  Severity, frequency, duration, and precipitating factors. o Denial and depression.  Use self­medication to deal with denial. o Kinds of mood disorders.  Major depression.  Exhibit difficulty in most basic task.  Last 6­12 months normally.  Dysthymia.  Longer term, but lower­grade of depression.  Atypical depression.  Uncommon.  The common diagnoses for adult children of alcoholics.  Experiences intense, sudden depression.  Abandonment depression.  Organic depression.  Occurring as a result of organic factors. o Brain tumors, head injuries, nutritional deficiencies,  physical illness, or substance use.  Prolonged use of opiates, benzodiazepines, alcohol, sedative  hypnotics, and stimulant drugs can produce depression.  Bipolar disorder.  Highest affective disorder associated with co­occurring disorders.  Common themes found in clients who have bipolar disorder and  substance abuse are: o A strong emphasis on depression instead of mania. o Predominance of hopelessness. o Specific pattern of medication noncompliance. o Patients self­medicating.  Cyclothymic.  Affective disorder and suicide. o Higher likelihood to commit suicide when using substances.  Self­destructive acts that might normally be contemplated and dismissed  are acted upon impulsively. o Can lead to cycle with shame.  Depressive feelings + shame = feelings of despair.  Feelings of despair + shame = suicidal ideation.  Suicidal ideation + shame = suicide. o Feelings of sadness are self­medicated in order to avoid this cycle.  Personality disorders and substance abuse. o Personality traits vs personality disorder.  Personalities define who we are.  Think of traits that describe the way we behave, experience life, and  interact.  When personality traits are persistently maladaptive and lead to chronic  difficulty in interpersonal, occupational, and social functioning they are  considered disorders. o Types of personality disorders.  Cluster A.  Odd and eccentric traits. o Paranoid, schizoid, schizotypal.  Cluster B.  Characterized by behavior that is erratic, emotional, and dramatic.  Has the strongest association with substance abuse.  Antisocial, borderline, narcissistic, histrionic.  Cluster C.  Feelings of fear and anxiety.  Substance occurs here, but not as commonly as in Cluster B.  Avoidant, dependent, obsessive­compulsive, passive­aggressive. o Personality disorders and chemical dependency disorders.  Is difficult to differentiate due to overlap in behaviors.  52% of male alcoholics had a current or lifetime diagnoses of antisocial  personality disorder.  Common use leads to question of if drug abuse and addiction lead to  behaviors that are characteristic of personality disorders.  Chicken or the egg? o What caused what? o Antisocial personality disorder.  Found in 2­3% of the male population.  Has strongest relationship with substance abuse.  Primarily attributed to men, whereas borderline is attributed to women.  Childhood precursors.  Conduct disorder and ADHD.  Have difficulty regulating behaviors and affect intolerance.  Inability to recognize emotions.  Substance use provide immediate gratification following regressive  behaviors.  Impulsivity, self­centeredness, passivity, affect intolerance. o Borderline personality disorder.  Second most common personality disorder associated with substance  abuse.  Abandonment depression is a common factor.  Feelings of emptiness and void, hopelessness and helplessness,  panic, guilt, suicidal depression, and homicidal rage.  Have mood instability.  Form intense attachments.  Treatment. o Address the mental illness and the substance abuse.  Treating one and ignoring the other will result in relapse. o Requires strong teamwork and communication among mental health caregivers. Chapter 12­ Alcohol/Drug Recovery and Relapse Prevention.  Approximately 1 million people in the US currently receive treatment for addiction.  Sobriety is an ongoing process.  Need for support. o Self­help meetings.  Most widely used approach for recovery.  AA.  Alcoholics Anonymous.  Founders found they could help each other through mutual support.  Meet on a regular basis to share their experiences, strengths, hope,  and support.  Basic principles were outlined into the famous 12 steps.  Factors that contribute to the success. o Mutual sharing.  Show others have been though same thing. o Support. o Frequent and regular meetings. o Availability. o Absence of fees. o Nondiscriminatory. o Establishment of goals.  71% of attendees improved.  57% after just ten meetings. o Social support empowers recovery.  Online social support networks. o Rational recovery.  An alternative to AA and other self­help meetings.  Based on rational­emotive approach.  Major focus is changing the way people feel and think about themselves  and their substance use.  Learn to take control of their emotions.  Stages of recovery. o Withdrawal.  0­15 days.  Most physical aspect clear up after 3­7 days.  Emotional feelings persist for 15 days.  Patients require education and direction. o Honeymoon.  15­45 days.  The opposite of the withdrawal stage.  Feeling energetic, confident, and optimistic.  Cravings are reduced.  May stray from recovery elements.  Times when they are most at risk to move on to another drug.  Assume they had a problem with one drug, not the other. o The wall.  45­120 days.  Largest percentage of relapse.  Get discouraged.  Lose hope, motivation, and strength.  May try to alienate support. o Adjustment.  120­180 days.  Get new hope and energy for recovery.  Accept it is a life­long struggle. o Resolution.  180­360 days. o Beyond.  1 year.  May need more in depth counseling.  Counseling and chemical dependency. o Early phases.  Safety and stabilization.  Help patient maintain sobriety and a sense of balance in their life.  Must determine if patient as emotional strength to deal with some  things. o If not patient will relapse. o Breaking through denial.  There is denial on the extent of the impact substance abuse had. o Affect, recognition, and modulation.  Works with patient to label and tolerate feelings.  Explore both conscious and unconscious levels of feelings.  Focuses on four areas of self:  Public self.  Private self. o Information person knows, but others don’t.  Blind self. o Thinks person is not aware of.  Personality, denial, etc.  Discovery self. o Category of the future. o Group therapy.  Safe environment to explore issues.  Have 4­8 members. o Family treatment.  There are 5 major family modalities.  Relapse prevention. o Recognizing the signs.  By doing so patient can avoid being blindsided by high­risk situation. o Habit.  Stages to change a habit.  Preparation. o Ex: quitting substance.  Implementation of the change. o Is difficult. o Ex: seeking help.  Maintenance. o Most difficult stage. o Ex: maintaining program despite stress. o Causes of relapse.  Three major categories that cause vulnerability.  Negative emotional states. o Causes 35% of relapses. o Experience negative moods and emotional states.  Interpersonal conflict. o Causes 16% of relapse.  Social pressure. o Causes 20% of relapse. o Cravings and urges.  Variety of things cause cravings.  Most effective way to cope is to detaching.  Ex: instead of thinking “I want a cigarette.” Think “I am  experiencing a craving to smoke.”  Trigger for craving.  Stimulus which has been associated with the preparation for or  actual use of the drug.  This includes peoples, places, thinks, times, emotional states, and  substances. o Can be induced by alcohol.  Rationalize they were addicted to drugs, not alcohol.  Once addicted to one drug they have an addiction potential for all drugs.  Relapse prevention strategies. o Once people understand what factors contribute to relapse that can try to prevent  relapse. o Lifestyle imbalance.  Need good structure. o HALTS.  Vulnerable states of mind and body.  Reminds person when they are vulnerable to relapse.  When they are:  Hungry.  Angry.  Lonely.  Tired.  Sick. o Interpersonal and social recovery support systems. o Healthy and physical well­being.  Exercising, taking care of body. o Cognitive, emotional, and spiritual self.  Have a sense of self.  Understand self. o AA serenity prayer.  God grant me the serenity to accept the things I cannot change, courage to  change the things I can. And wisdom to know the difference.  Striving for progress instead of perfection is the healthy goal.  Mindfulness. o A tool to enhance recovery. o Present awareness. o Addiction is described as Land of the Hungry Ghost.  The inability to see joy in everyday life. o Can help in being more present in life. o Foundation is compassion. o Help recognize and suppress negative emotional states. o Mindfulness­based behavioral relapse prevention.  MBRP.  Controlled drinking controversy. o Monitoring one’s own drinking in order to prevent a return to problem drinking. o Believe controlled drinking is a viable treatment approach for some problem  drinkers, not all.  Only when people have a stable marital and occupational background and  don’t have a family history of alcohol. o Appropriate for resistant clients who view abstinence as unachievable.  Harm­reduction approach. o Controlled drinking is one. o Roots in Netherlands.  Needle exchange program to reduce hepatitis spread. o Realistic perspective.  People are going to do drugs, so why not reduce their risk. o Methadone treatment program. o Advocacy for change in drug policies.  Changes in laws. o HIV/AIDS related intervention.  Needle exchange programs, prevention programs, referrals for testing. o Broader drug treatment options.  Methadone maintenance. o Drug­abuse management for those who wish to continue.  Promote safer, more responsible use. o Ancillary interventions. o Has caused controversy.  Treatment of co­occurring disorders. o Must set boundaries. o Four types of patients.  Dependent clingers.  Need attention.  Demanders.  Devalue and instill guilt in therapist.  Manipulative help­rejecters.  Have intense dependency needs.  Try recommendations, but nothing works.  Self­destructive deniers.  Continue abuse.  Seem to enjoy defeating recovery attempts. o Counseling for.  Breaking denial.  Educating and empowering patients.  Denial can be difficult to break through.  Developing skills.  Feelings and emotional buildup. o Help identify feelings and how they may build up into a  relapse.  Cognitive­behavioral approaches. o Instill hope and change depressive thinking. o Treatment compliance. o The family of the client.  Behavior of patient may expose family members to stress.  Goal of family treatment:  Acquiring knowledge.  Increasing self­awareness. o Each person’s role in the family.  Helping individual members make change in the system.  Maintaining family’s involvement in recover efforts.  Suicide. o 7­27% of alcoholics commit suicide. o 58% of suicides are by drug addicts. o Depression and substance abuser are co­indicators of suicide attempts. o Major depression that occurred before substance abuse predict severity of attempt. o Major depression that occurred during abstinence predicted number of attempts.


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