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Chapter 4 TRANSDISCIPLINARY FOUNDATION III: APPLICATION TO PRACTICE Contributor: Lori Phelps 4-1 Competency 9 Understand the established diagnostic criteria for substance use disorders, and describe treatment modalities and placement criteria within the continuum of care. • Substance-Related and Addictive Disorders • Diagnostic and Statistical Manual of Mental Disorders 5th edition, (DSM-5) Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-2 DSM-5: Substance-Related and Addictive Disorders 10 classes of substances Addictive Disorders = Gambling Substance-related disorders divided into two groups: 1. Substance Use Disorders • Previously split into abuse or dependence • Involves: impaired control, social impairment, risky use, and pharmacological criteria 2. Substance-Induced Disorders 4-3 Diagnostic Criteria Related to Substance Use Disorders “. . .a cluster of cognitive, behavioral, and psychological symptoms indicating that the individual continues using the substance despite significant substance-related problems.” “A pathological pattern of behaviors related to the use of the substance.” Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-4 10 Classes of Substances in DSM-5 1 “Addictive Disorder” •Alcohol •Caffeine •Cannabis •Hallucinogens • PCP • others •Inhalants • Opioids • Sedatives, hypnotics, and anxiolytics • Stimulants • Tobacco • Other • Gambling “Addictive Disorder” 4-5 Using larger amounts or for longer time than intended Persistent desire or unsuccessful attempts to cut down or control use Great deal of time is spent obtaining, using, or recovering Craving or a strong desire or urge to use Failure to fulfill major roles at work, school, or home Persistent social or interpersonal problems caused by substance use 6 Substance Use Dx Criteria (continued) •Important social, occupational, recreational activities given up or reduced •Use in physically hazardous situations •Use despite physical or psychological problems caused by use •Tolerance •Withdrawal (not documented after repeated use of PCP, inhalants, hallucinogens) Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-7 Assess Severity of Use for Diagnosis •Severity • Depends on # of symptom criteria experienced •Mild: 2-3 symptoms •Moderate: 4-5 symptoms •Severe: 6 or more symptoms 4-8 Substance-Induced Disorders Intoxication Anxiety Disorder Withdrawal Sleep Disorder Psychotic Disorder Delirium Bipolar Disorder Neurocognitive Depressive Disorder Sexual Dysfunction Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-9 Competency 10: Describe a variety of helping strategies for reducing the negative effects of substance use, abuse, and dependence. Competency 11: Tailor helping strategies and treatment modalities to the client’s stage of dependence, change, or recovery. Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-7 Stages of Change Prochaska & DiClemente 4-11 Prochaska and DiClemente’s Stages of Change “Wheel” • The stages describe a person’s motivational readiness or progress towards modifying the problem behavior • The change process is cyclical • Individuals move back and forth between the stages and cycle through at different rates Stages Defined • Precontemplation: Not considering change • Contemplation: Seriously considering quitting • Ambivalence • Preparation: Commitment to change • Planning for change • Action • Change underway • Maintenance: Stable change • Relapse prevention Recurrence Recurrence, often referred to as relapse, is the event that triggers the individual's return to earlier stages of change and recycling through the process. Can be viewed as part of the learning process Useful information for future change attempts (Treatment Improvement Protocol (TIP) Series, No. 35.) Chapter 1-- Conceptualizing Motivation And Change. Available from: http://www.ncbi.nlm.nih.gov/books/NBK64972/ Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 14 Stages of Change Model Applied https://www.youtube.com/watch?v=UpJJd6Kbsm4&feature=youtu.be Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 15 Competency 12 •Provide treatment services appropriate to the client’s personal and cultural identity and language. ©GardenProject/Shutterstock.com Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-16 Culturally Appropriate Treatment •Cultural factors include: •Heritage, history and experience, beliefs, traditions, values, customs •Cultural competence may be viewed on a continuum: •Cultural sensitivity •Cultural competence •Cultural proficiency Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 17 Competency 13: Adapt practice to the range of treatment settings and modalities 4-18 Competency 14 • Be familiar with medical and pharmacological resources in the treatment of substance use disorders. Free Download http://www.attcnetwork.org/regcenters/ productdetails.asp?prodID=935&rcID=5 A mobile app for your smartphone: http://www.findrxinformation.org/ 4-19 Competency 15 Understand the variety of insurance and health maintenance options available and the importance of helping clients access those benefits. •Federal Parity Law • requires group health insurance plans (with 50 or more insured employees) that offer coverage for mental illness and substance use disorders to provide those benefits in a way that is no more restrictive than all other medical and surgical procedures covered by the plan. Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 20 Competency 16 Recognize that crisis may indicate an underlying substance use disorder and may be a window of opportunity for change. •Brief Interventions •Short, problem-specific approaches •Used from risk to dependence •Help clients reduce or stop abuse Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 21 Knowledge and Skills for Brief Interventions •Overall attitude of understanding and acceptance •Counseling skills such as active listening and helping clients explore and resolve ambivalence •A focus on intermediate goals •Working knowledge of the stages-ofchange model Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-22 Three Steps In Active Listening 1. Listen to what the client says. ©Javier Brosch/Shutterstock.com 2. Form a reflective statement. To reflect your understanding, repeat in your own words what the client said. 3. Test the accuracy of your reflective statement. Watch, listen, and/or ask the client to verify the accuracy of the content, feeling, and/or meaning of the statement. Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-23 Competency 17 Understand the need for and use of methods for measuring treatment outcome •Effective, Evidence-Based Substance Abuse Services • Demonstrable, positive outcomes in terms of lowering recidivism, increasing victim satisfaction, or decreasing expenditures •Critical to improving outcomes, maximizing investment, and building support for further expansion of services 4-24 Internet Resources • The Assertive Community Treatment (ACT) EvidenceBased Practices (EBP) KIT http://store.samhsa.gov/product/Assertive-CommunityTreatment-ACT-Evidence-Based-Practices-EBP-KIT/SMA08-4345 • DSM-5: www.dsm5.org/ • http://www.psychiatry.org/dsm5 • SAMHSA’s National Registry of Evidence Based Programs and Practices http://nrepp.samhsa.gov/ Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-25 VIDEOS/WEBCASTS •Co-Occurring Disorders (introductory video) https://www.youtube.com/watch?v=nLseAvC8Heo&feature=youtu.be Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-26 Exercises/Activities •From TIP 35, Brief Interventions and Brief Therapies for Substance Abuse. Appendix D – Health Promotion Workbook http://www.ncbi.nlm.nih.gov/books/NBK64955/ Lori L. Phelps California Association for Alcohol/Drug Educators, 2015 4-27