17 -Treatment Models and Methods
Addiction Counselor Exam Review

 
 
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Addiction Counselor
Exam Review
Treatment Approaches & Settings
Instructor: Dr. Dawn-Elise Snipes
Executive Director AllCEUs.com
Podcast Host: Addiction Counselor Exam Review, Counselor Toolbox and Happiness Isn’t Brain Surgery

~ This presentation is available on our youtube channel at allceus.com/youtube or you can subscribe to the Addiction Counselor Exam Review Podcast on your favorite podcast app.
Objectives
~ Learn ASAM Dimensions
~Review Self help approaches
~ Identify different approaches to and levels of treatment
~ Define evidence based practices and clinical guidelines and identify where you can find them
ASAM Dimensions
~ Acute Intoxication/Withdrawal Potential (consider protracted withdrawal (PAWS))
~ Opioids, methamphetamine, marijuana, benzodiazepines and cocaine
~ Biomedical Conditions
~ Emotional, Behavioral and Cognitive Conditions
~ Readiness for Change
~ Relapse and Continued Use Potential
~ Recovery Environment
Self- Help Approaches
~ Types
~ 12-Step (Emotions, Alcohol, Schizophrenics…)/Double Trouble
~ Admitting that one cannot control one's alcoholism, addiction or compulsion;
~ Recognizing a higher power that can give strength;
~ Examining past errors with the help of a sponsor (experienced member);
~ Making amends for these errors;
~ Learning to live a new life with a new code of behavior;
~ Helping others who suffer from the same alcoholism, addictions or compulsions.

Self-Help
~ Key Features of 12-Step Programs
~ Accessibility
~ Anonymity
~ Social support and mutual aid
~ Promotion of self-esteem and efficacy
~ Introspection and insight
~ Spiritual recovery
~ Advocacy to promote social and legal remediese
Self-Help AA
~ Founded by Bill W and Dr. Bob
~ 1 million people estimated to have achieved recovery through AA
~ Main purpose to stay sober and help others
~ Abstinence is the only treatment
~ 3 legacies of AA
~ Recovery
~ Unity
~ Service
Self-Help Al-Anon
~ For SOs of people with addictions
~ Lessons
~ Not to suffer because of the actions or reactions of others
~ Not to allow ourselves to be used or abused by others
~ Not to do for others what they can do for themselves
~ Not to cover up for other’s mistakes
~ Not to create a crisis not to prevent a crisis if it is the natural order of events
Self- Help Approaches
~ Types
~ Rational Recovery
~ The primary force driving an addict's predicament is what Trimpey calls the “addictive voice”. When the desires of this “voice” are not satiated, the addict experiences anxiety, depression, restlessness, irritability.
~ The RR method is to first make a commitment to planned, permanent abstinence from the undesirable substance or behavior, and then equip oneself with the mental tools to stick to that commitment

Self- Help Approaches
~ Types
~ Women for Sobriety
~ Positive reinforcement (approval and encouragement)
~ Cognitive strategies (positive thinking)
~ Letting the body help (relaxation techniques, meditation, diet and physical exercise)
~ Dynamic group involvement.

Self- Help Approaches
~ Types
~ SMART Recovery
~ Teaches self-empowerment and reliance by
~ Point 1: Building and Maintaining Motivation
~ Point 2: Coping with Urges
~ Point 3: Managing Thoughts, Feelings and Behaviors
~ Point 4: Living a Balanced Life

Self- Help Approaches
~ Types
~ Celebrate Recovery
~ Realize I’m not God; I admit that I am powerless to control my tendency to do the wrong thing and that my life is unmanageable. (Step 1)
~ Earnestly believe that God exists, that I matter to Him and that He has the power to help me recover. (Step 2)
~ Consciously choose to commit all my life and will to Christ’s care and control. (Step 3)
~ Openly examine and confess my faults to myself, to God, and to someone I trust. (Steps 4 and 5)
~ Voluntarily submit to any and all changes God wants to make in my life and humbly ask Him to remove my character defects. (Steps 6 and 7)
~ Evaluate all my relationships. Offer forgiveness to those who have hurt me and make amends for harm I’ve done to others when possible, except when to do so would harm them or others. (Steps 8 and 9)
~ Reserve a daily time with God for self-examination, Bible reading, and prayer in order to know God and His will for my life and to gain the power to follow His will. (Steps 10 and 11)
~ Yield myself to God to be used to bring this Good News to others, both by my example and my words.
Self- Help Approaches
~ Benefits
~ Provide network outside of treatment
~ Teach recovery skills
~ Helps clients take responsibility for recovery
~ Provides a sense of belonging
~ Helps develop a new identity
Break
~ Addiction Counselor Exam Review is produced by AllCEUs
~ AllCEUs offers unlimited Continuing Education for $59 as well as precertification training in addictions and behavioral health starting at $99
Types of Treatment
~ Detox (ambulatory or residential)
~ Minimize physical harm
~ Point of first contact
~ Alcohol, benzodiazepine and opioid withdrawal may require 24-hour medical care for safety or humanitarian concerns
~ 3 components
~ Evaluation
~ Stabilization
~ Fostering client entry into treatment

Types of Treatment
~ Outpatient Treatment (ASAM Level I)
~ Suitable for individuals who are working and have sufficient social support
~ Lasts between 3 months and 1 year
~ Can be highly structured or “drop-in”
~ Intensive outpatient (ASAM II.1) and PHP (ASAM II.5) provide
~ Pharmacotherapy
~ Relapse prevention planning
~ Individual counseling
~ Family therapy
~ Vocational counseling
Types of Treatment- MAT
~ MAT can be provided in an outpatient setting or physician’s office
~ Combines pharmacotherapy with a full program of assessment, intervention and support
~ MAT Outcomes
~ Improve treatment retention
~ Decrease illicit opioid use
~ Increase abstinence from opioids and alcohol
~ Decrease criminal justice involvement
~ Increase employment
~ Improve mental health

Types of Treatment- MAT
~ MAT Drugs
~ Naltrexone (vivitrol)
~ Disulfram (Antabuse)
~ Acamprosate (Campral) Reduces symptoms of protracted W/D from alcohol (insomnia, anxiety)
~ Methadone
~ Buprenorphine (suboxone/subutex)
~ Bupropion and Varenicline (Nicotine withdrawal)
~ MAT is available for
~ Opioids
~ Alcohol
~ Tobacco

Types of Treatment
~ Residential (ASAM Level III.5)
~ 24-Hour intensive medical, psychiatric, psychosocial treatment
~ Duration of treatment 28 days to 1 year
~ Therapeutic Community
~ Highly structured 6month to 2 year program
~ Heirarchical model: Increased individual and social responsibility
~ System of rewards and punishments
~ Tends to be more confrontational

Types of Treatment
~ Half-way houses (Recovery residences: NARR Level 4)
~ Clients live at the house, work and receive treatment at the residence

Treatment approaches and evidence based practice
~ Evidence based practices have been shown through available scientific evidence to consistently improve measurable client at comes
~ The goal of evidence based practices to integrate clinical expertise, external scientific evidence, an client values to provide high quality services
~ Available evidence based practices can be found on SAMHSA’s national registry of evidence based programs and practices nrepp.samhsa.gov
Examples Of Evidence Based Practices
~ Seeking Safety
~ Motivational Interviewing
~ 12 Step Therapy
~ Behavioral Couples Therapy
~ Cognitive Behavioral Therapy
~ Solution Focused Brief Therapy
~ Community Of Reinforcement Approach With Vouchers
~ Dialectical Behavior Therapy
Evidence Based Practices Continued
~ Successful implementation of evidence based practices includes
~ Changes in professional behavior
~ Changes in organizational structures and cultures
~ Changes in relationships to service recipients and other potential partners
~ There can be significant implementation failure of programs and practices that are not delivered with fidelity
~ Programs often lose their fidelity to new protocols over time or when they are implemented in unique settings
~ Fidelity checklist can be used to identify critical components of an approach
~ Many evidence based practices today require extensive supervision and certification in that evidence based practice
Clinical Practice Guidelines
~ The purpose of clinical guidelines is the same as for the evidence based practices, to translate research into practice, increase the effectiveness of treatment, provide a framework for collecting data about treatment, ensure accountability to funding sources, and encourage some consistency in practice
~ Where to find them….
Break
~ If you are looking for curriculum based group and individual activities for clients, Journey to Recovery By Dr. Dawn-Elise Snipes is available on Amazon and provides over 350 pages of activities.
Summary
~ Treatment serves are available in a range of settings from outpatient to full hospitalization based on client’s ASAM ratings
~ Self help provides a network of support outside of treatment
~ Evidence Based Practices are research based approaches designed to translate theory into practice.
~ Clinical Guidelines are freely available through SAMHSA, the APA and other professional associations