187 -Models of Treatment
Counselor Toolbox

 
 
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Models of Treatment
Instructor: Dr. Dawn-Elise Snipes
Executive Director: AllCEUs.com, Counselor Education and Training
Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery

Objectives
~ Define the principles of effective treatment
~ Explore current trends and practices
~ Identify common approaches to treatment
~ Identify the main components of each approach
~ Compare and contrast each approach
Principles of Effective Treatment
~ Addiction and mental health issues are complex but treatable conditions that affect:
~ Brain
~ Body
~ Behavior
~ No single treatment is appropriate for everyone
~ Treatment needs to be available to be effective
~ Effective treatment attends to multiple needs of the individual

Current Trends and Practices
~ Focus on client competencies and strengths
~ Individualized, client-centered treatment
~ Shift away from labeling
~ Acceptance of new treatment goals (other than just abstinence)
~ Adoption of a recovery paradigm and away from the problem-focused, acute care model
~ Achieve a rich and meaningful life vs. eliminate depression
Current Trends and Practices
~ Integration of addiction treatment in multiple disciplines esp. primary care, mental health and addiction
~ Use of evidence based practices
~ Use of medications
~ Telehealth technologies
~ Support groups (in the rooms, daily virtual support groups)
~ Chat support
~ Forums
~ Online video psychoeducation
Question
~ How can we make treatment more available?
Principles of Effective Treatment
~ Duration in treatment for at least 3 months is critical
~ Treatment plans must be assessed continually and modified to ensure that it meets the person’s changing needs
~ Treatment does not need to be voluntary to be effective

Models of Treatment
~ Medical model
~ Chronic progressive disease
~ Often hospital or doctor office based
~ Uses a biopsychosocial approach with emphasis placed on:
~ Physical causes
~ Pharmacotherapy
~ Detoxification
~ Symptom reduction
~ Aversion
~ Medical maintenance
Models of Treatment
~ Spiritual Model
~ Mood issues and addiction may be caused by spiritual emptiness which leads to character defects such as pride, resentment, anger
~ Less weight to causation and more emphasis on a spiritual path to recovery, development of values and a sense of meaning and purpose.
~ 12-Step Models (Mutual Help)
~ Emphasize that one cannot help oneself, and recovery requires surrender of one’s will to a higher power.
~ NA, AA, EA
Question
~ How can you use a spiritual model with clients who do not believe in a higher power?
Models of Treatment
~ Psychological (self-medication) Model
~ Addiction and mental health issues result from deficits in learning, thinking or emotion regulation
~ Treatments
~ Behavioral self-control
~ Individual and group counseling (Multiple EBPs)
~ Pharmacotherapy for mental health issues
Psychological: Behavioral Self Control
~ Goals
~ Strengthen internal mechanisms (self-awareness)
~ Establish external controls
~ Coping skills
~ Goal setting
~ Behavioral contracting (What would you contract for?)
~ Trigger management (What are MH triggers)
~ Functional Analysis (of behaviors NOT diagnosis)
~ Relapse prevention (What are relapse prevention strategies for MH? Addiction?)

Psychological: Psychotherapeutic
~ Dialectical Behavior Therapy
~ Why
~ Clients unintentionally rewarded ineffective treatment while punishing their therapists for effective therapy.
~ The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format.
~ Clients found the focus on change inherent to CBT invalidating. (How might this be true in addiction?)
~ Clients felt their suffering was being underestimated, and therapists were overestimating their helpfulness
~ “You are doing it, or feeling incorrectly.”
Psychological: Psychotherapeutic
~ Dialectical Behavior Therapy
~ Over Riding Themes
~ Mindfulness (wise mind)
~ Distress tolerance
~ Emotion regulation
~ Interpersonal effectiveness & problem solving
Psychological: Psychotherapeutic
~ Matrix Model for Stimulant Use
~ A 45 session treatment program
~ Goals:
~ Learn about issues critical to addiction and relapse
~ Receive direction and support from a trained therapist
~ Become familiar with self-help programs.
~ The therapist functions simultaneously as teacher and coach, fostering a positive, encouraging relationship
Psychological: Psychotherapeutic
~ Motivational Enhancement Therapy
~ Helps resolve ambivalence about treatment & abstinence
~ This therapy consists of:
~ Initial assessment battery
~ Followed by 2-4 individual sessions with a therapist
Psychological: Psychotherapeutic
~ Motivational Enhancement Therapy
~ This therapy consists of (cont…):
~ First treatment session (FRAMES)
~ Feedback about the initial assessment
~ Responsibility
~ Elicits self-motivational statements
~ Strengthens motivation and builds a plan for change
~ Advice: Coping strategies for high-risk situations are suggested
Psychological: Psychotherapeutic
~ Motivational Enhancement Therapy
~ This therapy consists of (cont…):
~ First treatment session
~ Menu of Options
~ Empathy
~ Self-Efficacy
~ Subsequent sessions: therapist monitors change, reviews change strategies being used, encourages change
Psychological: Psychotherapeutic
~ Family Behavior Therapy (FBT)
~ Demonstrated positive results in both adults and adolescents
~ Addresses not only substance use and mental health problems but other co-occurring issues (i.e. conduct disorders, child mistreatment, family conflict, and unemployment)
~ FBT involves the patient along with at least one significant other such as a cohabiting partner or a parent
Psychological: Psychotherapeutic
~ Family Behavior Therapy (FBT)
~ FBT combines behavioral contracting with contingency management.
~ Therapists seek to engage families in applying the behavioral strategies taught in sessions and in acquiring new skills to improve the home environment.

Psychotherapeutic
~ Seeking Safety
~ Present-focused therapy for trauma/PTSD and addiction
~ Available as a book, with guidance for clients and clinicians
~ Can be done in individual or group
Psychological: Psychotherapeutic
~ Introduction/Case Management
~ Safety, PTSD: Taking Back Your Power
~ When Substances Control You
~ Honesty, Asking for Help
~ Setting Boundaries in Relationships
~ Getting Others to Support Your Recovery
~ Healthy Relationships
~ Community Resources
~ Compassion
~ Creating Meaning
~ Discovery
~ Integrating the Split Self
~ Recovery Thinking
~ Taking Good Care of Yourself
~ Commitment
~ Respecting Your Time
~ Coping with Triggers
~ Self-Nurturing
~ Red and Green Flags
~ Detaching from Emotional Pain (Grounding)
~ Life Choices
Models of Treatment
~ Sociocultural model
~ Emphasis is placed on the socialization process, culture, observational learning and reinforcement of behaviors
~ Recovery involves:
~ Building new social and family relationships
~ Developing social competency/interpersonal effectiveness
~ Working within one’s cultural infrastructure
Models of Treatment
~ Relapse Prevention
~ Adopt strategies designed to help clients
~ Become aware of cues or “triggers” that make them more likely to abuse substances or become symptomatic
~ Develop alternative coping responses to those cues
Medication Assisted
~ Addiction
~ Methadone
~ Suboxone
~ Vivitrol
~ Antabuse
~ SSRIs
~ Mental Health
~ SSRIs
~ Atypical antipsychotics

Harm Reduction
~ Acceptance that drug use and mental health issues are a reality
~ Preventing the harm caused by them
~ 4 Ls: Liver, Lover, Livelihood, Law
~ Interventions
~ Low-threshold pharmacological interventions
~ Needle exchange programs
~ Emphasis on non-injection routes
~ Involvement of those with a history of use or distress in program development

Multidisciplinary (Biopsychosocial-Spiritual)
~ Psychotherapeutic interventions fro co-occurring issues
~ Medication assisted therapy for both addictive and mental health issues
~ Wrap around services to ensure people have access to necessary resources to achieve their goals
~ Family therapy to improve the interpersonal environment of the person

Summary
~ There are many approaches to dealing with mental health and addiction issues
~ Since co-occurring disorders are the expectation, it makes sense to be aware of strategies to address both/all issues
~ Current trends and practices are steering clinicians to use a more individualized, strengths-based, biopsychosocial-spiritual approac