Last Half of Semester Notes
Last Half of Semester Notes SOW 4700
UWF - Pensacola
Popular in Substance Abuse
Popular in Social Work
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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