Substance Abuse Treatment and Recovery, Exams of Advanced Education

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Culture-bound syndrome - illness truly bound to specific culture; refer to otherwise common mental or physical illnesses that are subsequently construed as unusual because of pathoplastic influence of clture (e.g, hallucinatory sx of schizophrenia could be due to demon possession) pharmacological therapy and psychotherapy - two key mental health treatment paradigms of Western medicine (multimodal therapy) racism and discrimination - refer to attitudes, beliefs, and practices that prejudge and denigrate individuals or gs based on disparate phenotypic characteristics (skin color, hair texture, facial features, etc) or ethnic minority group affiliation What is the trend for cultural diversity in the US? - increasing rapidly and steadily; by 2025, 40% adults (48% children) will be from ethnic and racial minority gps. HIV - the viral agent that causes AIDS (Acquired Immunodeficiency Syndrome), which is the final stage in the HIV disease process; most prevalent in men having sex with men and IV drug users; contributes to poverty, homelessness, an other medical problems 50% - percent increase in the number of seniors needing substance abuse treatment. 70% rate of increase in treatment Limits to confidentiality - 1. Client request for release of information

2. Court orders for release of information
3. Danger to self
4. Danger to others
5. Suspected Child abuse/neglect cause by a client
6. Grave disability CAGE questionnaire - Have you ever felt you should CUT DOWN on your drinking? Have people ANNOYED you by criticizing your drinking? Have you ever felt bad or GUILTY about your drinking? Have you ever had a drink first thing in the morning to steady your nerves (EYE-OPENER)?

• 4 - question on alcohol abuse MAST - Michigan Alcoholism Screening Test - yes or no to 25 questions to explore number of treatment issues; most accurate and oldest screening tool to identify drinkers with 98% accuracy

What is another cultural issues beyond the client's culture? - counselor's culture Relapse-remitting model of addiction - recognizes that some issues tend to return cyclically overtime, can help counselor and CLT make advance contingency plans to avoid having brief relapse in negative circumstances or behaviors Authentically connected referral network - refers to a carefully established set of services providers prepared to meet client needs; goal is for all network agencies an providers to recognize their valued and essential roles in the addiction treatment process and for clients to recognize this and respond with similar trust and confidence. What is the primary aim of case management services, beyond providing seamless care and being client-centered? - to provide least restrictive level of care Ask-teLl-ask technique - asking permission of the client to talk with them, telling them of any concerns you have, and then asking for their thoughts on what you shared. Referral form - used to track the results of the referral; WHO (identifies the client and counselor involved/demographic info; substance use, legal issues, family concerns) WHAT (issues that generated the need for the referral, substance/work, family, and goals and commitments) HOW (address how CLT was engaged and dealt with) When should planning for aftercare be engaged - at the point of initial counselor-client contact What should be the focus of treatment mostly? - positive education and skills in substance abuse triggers, patterns of use, and relapse prevention; substance issues, recovery, health issues, co-occurring disorders; holistic treatment planning an interventions are essential in recovery process Bookend term in substance abuse treatment means.. - discussing a trigger event with someone trusted before and after it occurs Trigger events - often crisis stressors or situations CFR 42, part 2 - confidentiality in areas of alcohol and substance abuse. confidentiality restriction apply:

1. to records, w/c may not be disclosed even in admin, civil, criminal, or legislative proceedings by any govt authority
2. to communications, even if the person seeking information already has it, cold otherwise obtain it, is an official or law officer, has a subpeona or otherwise claims the right of information release not permitted in the CFR
3. to acknowledgements, such as regarding the presence of a client (unless he/she is in a facility or facility area not dedicated solely to alcohol or drug abuse tx, ad no mention of drug or alcohol treatment is made)

How is subpoena will be valid for release of information? - if a court of competent jurisdiction also explicitly enters an order authorizing information release specific to the 42CFR part 2 regulations What does HIPAA statues guidelines address? - health privacy and confidentiality standards; governs the management and release of protected health information (PHI); right to privacy for all adults and minors ages 12- 18 DHHS Privacy Rule 3 additional privacy protections - 1)consent of ROI must comply with 45CFR 2)clients gets copy of ROI 3)copy is kept for 5 yrs from its exp date How does group therapy and 12-step program differ? - Group therapy - focuses on helping individuals to examine, understand, and interpret the intrapsychic and interpersonal influence and conflict that motivate and perpetuate substance abuse; denial is explored 12 - step prg - centered on drawing upon focuses such as affiliation, peer confrontation and support, and creating a culture of abstinence and the mutual accountability to sustain it; denial is confronted and broken down What are the 5 primary group models used in substance abuse treatment? - 1) Psychoeducation

• teach about substance abuse

2. Skills development - hone on skills to break free of addiction
3. Cognitive-behavioral - rearrange patterns of thinking/action that lead to addiction.
4. Support group - Provide a forum where members can support constructive change.
5. Interpersonal process group - enable members to rethink past problems/solutions that led to substance abuse When does positive effects of treatment starts to emerge? - around 3 mos is the baseline duration for improved outcomes 3 most common recovery stages - 1) early - entering treatment, embarking on abstinence, and staying sober; relapse vulnerability remains high
6. middle - lasts from 1-12 mos, greater confidence in abstinence grows, cravings persist but are recognized and deflected successfully; lifestyle and personality trait changes are progressing, relapse vulnerability persists but less significant
7. late/maintenance - maintaining abstinence while improving life in other areas, addressing psychological or relationship issues that became apparent through abstinence, and continuing all relapse prevention behaviors and skills previously learned Expressive group therapy - allows clients various ways of expressing self via alt methods and allows greater exploration of their thoughts, bodies, and feelings; tap in ot their imaginations to better and more safely examine their bodies, feelings, emotions, and thought processes

Culturally specific groups - offer opportunities to explore the role of culture in substance abuse and strengths and handicaps it may produce during the change process Relapse prevention groups - offer clients opportunity to focus intensely on skill development to identify, understand, and mng situations, people, and thoughts that may trigger relapse. 5 Phases of Group Therapy - 1) Forming - engaging info and creating bonds; tentative overtures, polite exchanges, and worries about fitting in.

2. Storming - dissatisfaction, disagreement, competition, and conflict; criticizing ideas, interrupting, hostility, and attendance issues
3. Norming - forming group structure, establishing roles and relationships, cohesion development, and harmony creation
4. Performing - tasks focus, emphasizing productivity, and identifying achievements
5. Adjourning - task completion, ending duties, and dropping dependency; feeling regrets, emotion mgt, disbanding Within the family unit, who are likely to telescope substance abuse issues intergenerationally? - childre, as they group up to become overprotective, overly controlling , dependent, or otherwise unbalanced in their own marriage and parenting practices How many percent of all HIV cases are among adolescent and adult females in the US? - 25%. Although HIV continues to be predominantly affect men who are sexually active with other men, women are susceptible to contracting HIV; Black and Latina acct for 4/5 of all HIV cases in women What is the most likely period in life for substance abuse problem to begin? - adolescence, but it can fluctuate throughout life course 3 Types of Youth Substance Abuse Prevention Programs - 1) Universal - address both risk and protective facots in general community or school settings 2 ) Selective - oriented to engage youth that possess specifically identified risk factors that increase their likelihood of developing a SUD
6. Indicated - address issues relevant to youth who have already allowed substance abuse into their lives *central to all is education regarding the harms caused by substance abuse as such education has proven to reduce experimentation and lower rates of cont substance abuse in youth Why is there a need for accurate documentation? - it is essential in determining a proper treatment plan and ensuring that the pan evolves appropriately as the CLT makes cont progress. Also, agencies req doc. to ensure that funds entrusted to the prog are being utilized as agreed upon What are the essential information needed for intake assessment? - 1) psychoactive substance abuse hx and patterns of use

2. psychological health and psychiatric tx hx
3. current physiological health, nutrition, med hx
4. hx and current meds
5. basic demongraphics
6. legal hx
7. educ
8. recreational act hx
9. religion/spirituality
10. sexual orientation
11. high-risk sexual and substance use practices
12. family hx and current support network How often are treatment plans typically updated? - 30 - 90 days or as changes arise progress notes - charts the trajectory of the client's progress towards the goals, objectives, and actions steps based on treatment plan; must be recorded w/in <14 days and reviewed when updating tx plan How often should active client's charts be updated? - no less than a week What are the required contents discharge summary? - 1)whether the program was or was not completed successfully
13. reasons that resulted in CLT d/c
14. d/c voluntary/involuntary
15. transfer/referrals involved in d/c
16. summary info on tx offerred and recovery lvl achieved
17. clt's status in abstinence or cont substance use
18. educational/voc accomplishments
19. legal status
20. relevant cont med issues 10)any involved supports or services that are expected to be cont beyond d/c What is the most important mission of a drug treatment agency? - to break the cycle of abuse and relieve the individual, involved families, and society as a whole form the suffering involved Anchoring - counselor leads clt to relax, close his eyes, and focus on breathing and the immediate environment; have the CLT recognize the immediate present is safe inspite of worries about the past or future Mirroring - counselor has the CLT synchronize his breathing with the counselor's, leading to a calm rate (counselors avoid this tech if transference intimacy has been an issues) Timeout - counselor allows the CLT to take a break from the topic, leaving the room if necessary, to relax before continuing

What is the DSM 5 criteria for Substance Abuse Disorder? - 2 out of 11 sx must have occurred w/in the last 12 mos.

1. tolerance
2. withdrawal
3. increase in the amt of drugs taken
4. inability to control use
5. large amt of time and effort to obtain drug in question
6. giving up impt act
7. cont use regardless of ill effects
8. cravings
9. recurrent us leading to inability to fulfill major role
10. recurrent us thought it is physically harmful
11. recurrent use though it leads to social problems drug tolerance - the tendency for larger doses of a drug to be required over time to achieve the same effect; decreased sensitivity to a drug over time drug cue - key euphoric memories that become connected to sights, sounds, smells, people, and places previously associated to drug-uses; triggers Wernicke-Korsakoff syndrome - Organic brain syndrome resulting from prolonged heavy alcohol use, involving confusion, unintelligible speech, and loss of motor coordination. It may be caused by a deficiency of thiamine, a vitamin metabolized poorly by heavy drinkers. 80-90% of Wernicke (poor muscl coordination, oculomotor, short-term cond due to yrs of alcohol; Vit B1 deficiency) --> Korsakoff (loss of older memories, psychosis) Alcohol-related physical illness - Alcoholic hepatitis - abdominal pain, nausea, vomiting, and a swollen liven; jaundice and bleeding Steatosis - fatty deposits in the live that can be fatal Cirrhosis - scarring of the liver from alcohol damage Hepatic encephalopathy - reversible dementia, high blood toxins Formication - Hallucinatory behavior produced by chronic cocaine or amphetamine abuse, in which the individual feels insects or snakes crawling either over or under the skin. (aka - magnon's syndrome, coke/crackbugs) Most damaged organ due to cocaine abuse - heart - arterial narrowing leading to death 3 main types of Amphetamines - Amphetamine sulphate - speed, Benzedrine Destroamphetamine - dexedrine/Dexy's midnight runners Methamphetamines - Methedrine/meth, crank, speed, poor man's cocaine; greatest abuse risk doe to intense rush; generally pleasurable to most users; 2nd to marijuana as non-alcoholic drug most abused worldwide

Convergence Theory - substance abuse rates between men and women are become more equal What rank does alcohol use d/o among psych d/o in the elderly? - 3rd early-onset alcoholism - onset of alcohol abuse in adol or young adult; represent 2/3 of all individuals with alcohol use d/o late-onset exacerbation drinking - individuals with intermittent hx of alcohol abuse that only became chronic in late adulthood late-onset alcoholism - Used to describe the onset of alcoholism after the age of 65 Related to loneliness, loss of spouse, or disabling condition What is the first requirement in meeting with a new client? - establish rapport goal of motivational interviewing - To facilitate motivation to change and to leverage the client's own resources for change; involves exploring and resolving ambivalence 5 Fundamental Principles of MI - 1) reflective and emphatic listening

2. identification of variances between beh and personal goals
3. deflection of confrontation or argument to more positive, goal-oriented dialogue
4. redirection of CLT resistance to desires and goals than opposing
5. nurturing optimism and sense of self-efficacy when confronted with obstacles, challenges, and negative expressions How many percent of individuals with co-occuring d/o will get treatment for both d/o, for mental health only, and for substance abuse treatment only? - 7.4% both, 32.9 % mental health only, 3.8 substance abuse only T/F: Certified Substance Abuse Counselor can diagnose and treat mental health d/o. - false, CSACs dont' have the credentials and training to do so. thus impt to collaborate with other providers GATE - use to evaluate SI and behaviors by substance abuse counselor working with at-risk clients G - gather information, screen for suicidality and observe warning signs A - access supv or consult T - take responsible action to protect CLT's wellbeing E - extending the action to secure f/up and monitoring Serious mental health sx (delusions, suicidality, hallucinations)that are resolved within 30 days or less are most likely due to what... - substance abuse-induced d/o hat require cont

abstinence... if cont to exist then most like there's underlying mental health issues and needs to be addressed/treated CRAFFT - 6 - item screen for alcohol or drugs in adolescents, 14- 18 (C=car, R=relax, A=alone, F=forget, F= family or friends, T= trouble) AUDIT - Alcohol Use Disorders Identification Test MAST - Michigan Alcoholism Screening Test - yes or no to 25 questions. Screening - to determine need for placement ASAM's Assessment Dimension - 6 dimensions

1. Acute intoxication or withdrawal potential
2. Biomedical cond and complications
3. Emotional, behavioral or cognitive conditions and complications
4. Readiness to change
5. Relapse, cont use or cont problem potential
6. Recovery environment ASAM Levels of Care - 5 Specific Levels of Care but only 4 Levels of TX 0.5: Early Intervention - early intervention, education for at-risk behaviors but substance abuse diagnosis can't be confirmed 1: Outpatient Services - education counseling and beh change 2: Intensive Outpatient Services/Partial Hospitalizaiton - comprehensive biopsychosocial assessments and individualized tx plan 2.1 Intensive Outpt 2.5 Partial Hospitalization 3: Residential/Inpatient Services - planed regimen of care 24 hr live-in setting 3.1 clinically managed low intensity res svc 3.3 clinically managed high intensity, specific pop res svc 3.5 clinically managed high intensity res svc 3.7 medically monitored high intensity inpt svc 4: Medically Managed Intensive Inpatient Services - 24 hr medically directed eval and tx of substance-related and mental d/o i nacute care setting precontemplation stage - no thought to change, feeling resigned to substance abuse, loss of control, denial, minimization of consequences experienced contemplation stage - evaluation of the costs, benefits, and burderns associated with the substance abuse beh as well as those involved in the proposed change

preparation stage - early experimentation with minor changes in use patterns to better evaluate ideal of change proposal action stage - people are actively changing a negative behavior or adopting a new, healthy behavior maintenance stage - sustained change over time; begins 6 months after action has started and continues indefinitely; efforts to maintain change relapse stage - clients need renewed commitment and motivation b/c they have lost interest or become discouraged; part of stages of change CMRS scale - use to determine CLT readiness for substance abuse treatment; 18 likert-type response 4 Domains C - circumstance, external pressures influencing substance abuse change M - motivation, internal pressures driving change R - readiness, perception and acceptance of the need for treatment S - suitability, clt's perception of the appropriateness of tx modality or setting Acronym for guiding treatment planning - M - measurable A - attainable T - time-bound R - realistic S - specific How often should tx plan be updated for individuals with the criminal justice sys? - at all transition points Addiction Severity Index (ASI) - developed by DENS (Drug Eval Network Sys) among the most widely used and reliable and valid assessment instruments in the field. 6 Problem Domains

1. medical status
2. employment and support
3. alcohol and drug use
4. legal status
5. family and social relationships
6. psychiatric status. It tells us which problem areas are the most significant and require attention. T-ASI (teen) and ASI-Lite (shortened) Reliability - consistency of measurement Validity - The ability of a test to measure what it is intended to measure

SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) - assessment for motivation, 19 - item self-report instrument with 3 main scales (recognition, ambivalence, and taking step); 2 versions, 1 for alcohol use and 2nd for other personal drug use Key Components of TX plan - 1) problem statement, w/c are based from assessments

2. goal statements, from problem statements
3. objectives, clt's responsibility
4. interventions, counselor's tasks to support clt SOAP note - S: subjective O: objective A: assessment P: plan DAP note - Data Assessment Plan DIG FAST - Symptoms of Mania Distractibility Irresponsibility Grandiosity Flight of Ideas Activity and Agitation Sleep (decreased need) Talkativeness T/F Substance abuse is a chronic and untreatable condition - False, it is treatable with close monitoring based on the Center for Substance Abuse Treatment (CSAT) Minimum of treatment time in the Intensive Outpatient Tx (IOT) according to ASAM - 9 hrs/wk Core Features of Center for Substance Abuse Treatment - intake and orientation, full biopsychosocial assessment, individualized tx planning, individual/family/group counseling, psychoed, case mgt, linkages w/ mutual-help and community-based support gps, 24-hr crisis support, med tx, formal drug screening/monitoring, ed/voc services, psychiatric eval and psychotherapy, med mgt, d/c planning/transition svcs. types of learning styles - Aural/auditory - through sound Visual - via images Verbal - through workd Physical/Kinesthetic - through touch

Logical - mathematical, through logic Social/interpersonal - with others Solitary/intrapersonal- through self-study Core treatment and recovery skill - 1) Substance Abuse refusal training - helps clts to practice and become comfortable with refusing addictive substances.

2. Stress mgt/relaxation training
3. Assertiveness Naltrexone - Opioid antagonist that is given orally in alcohol dependency programs; effective in treating opioid addiction Naloxone (Narcan) - shorter-acting agent similar to Naltrexone,; used primarily in situations of opioid OD, also used in TX of alcoholism to lower cravings. bupenorphine and bupenorhphine w/ naloxone - tx for opiod dependences 4 Sequential Stages of TX - 1) Treatment engagement
4. Early Recovery.
5. Maintenance
6. Community support Treatment engagement - 1 of 2 Stages of TX - - establish a tx contract including goals and CLT responsibilities; resolve acute crises; develop a therapeutic alliance; prep tx plan Early Recovery - 2 of 4 Stages of TX - - cont abstinence; sustain beh changes; terminate a drug- using lifestyle and develop drug-free alt; learn relase triggers and prevention strategies; identify and resolve contributing personal problems; begin 12-step or mutual self-help prg Maintenance - 3 of 4 Stages of TX - - solidify abstinence; deepen relapse prevention skills; enhance emotional functioning; increase sober social networks; and address other problem areas Community support - 4 of 4 Stages of TX - - sustain abstinence and a healthy lifestyle; establish treatment independence; extend social network ad support gp connections; pursue healthy community act; solidify impt outlet act and pursue new interests What is the minimum duration of days in an Intensive Outpatient Treatment? - 90 days, but longer stay is better; >9 hrs for 3-5 days/wk Which is more effective in providing relapse-prevention training, individual or group therapy? - Both are equal List Types of Intensive Outpatient Treatment - 1) Psychoed

2. Skills development
3. Interpersonal
4. Family
5. Support Psychoeducational groups - A group set up to increase knowledge or skills about a specific somatic or psychological subject and allow members to communicate emotional concerns. focus on key concepts regarding substance use disorder and its consequences; time-limited, ideal for outset of treatment; allows more objective examination of dysfunctional beliefs, problem thinking patterns, Skills-development group - focus on refusal training, relapse prevention, assertiveness training, and stress mgt Support group - address immediate issues along with ways to change negative thinking, emotions, and behavior, learning new ways of relating, managing conflict w/o violence or relapse, and evaluating how actions affect others. Interpersonal process groups - singe-interest grps focused on specialized issues, usually later in tx Family/couples groups - explore effects of substance use on relationships. What is the most common duration of counseling in an IOT(intensive outpatient tx)? - 30 - 50 mins, 1x/wk What is the common format of individual counseling in IOT? - 1) asking for reactions to recent gp mtg
6. reviewing outside act since last sess
7. asking about current feelings
8. exploring any interim drug and alcohol use
9. inquiring about any urgent issues *CLT with co-occurring d/o may req primarily individual counseling T/F Topics addressed in pschoeducation gps are typically determined by the gps prevailing drug of choice - F; sequenced by concept for maximal effectiveness. can start from understanding the relapse process all the way to maintaining a balanced life CIWA-Ar - Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised 9 item symptom rating scale, max score 67; <10 does not warrant intervention; 20 or higher warrant medical inpt setting; reviewed verions have enable d monitoring for both benzo and opioid withdrawal

T/F Pharmacotherapy and med mgt are not impt in substance abuse tx - False; they are found to be effective in tx and must not be overlooked What drugs of abuse lack effective treatment meds? - no effective meds for dependence on stimulants such as cocaine, marijuana, inhalants, or hallucinogens. but meds to mitigate withdrawal sx are found What are adjunctive therapies for substance abuse tx? - adjunctive therapies - used to engance the emotional and psychological functioning of CLTs laboring to overcome an addictions Creative media groups; acupuncture and biofeedback tx; meditation What type of meds can lessen the sx of psychosis and delirium related to stimulant withdrawal?

• Neuroleptic meds What medication can reduce the sx of agitation and anxiety related to stimulant withdrawal? - Benzodiazepines Smoking cessation - should be considered if CLT desires it; Bupropion and nortiptyline can help reduce nicotine cravings as it also help reduce depression - which is major cause of relapse Disulfiram (Antabuse) - is indicated with cocaine use or methadone maintenance; produces severe physical reaction if drinking occurs w/in 12hrs-7 days base on dosage; sandwich technique - interviewing technique ; sandwiching std screening and assessment questions between 2 less formal discussions What are the 3 screening instruments that were found to be accurate in determining the presence of substance use d/o? - 1) CSAT (Center for Substance Abuse Treatment) Simple Screening Instrument

2. combined Alcohol Dependence Scale (ADS) and Addiction Severity Index (ASI)-Drug Use Subscale
3. Texas Christian University Drug Screen SDSS - Substance Dependence Severity Scale, provides DSM and ICD substance abuse d/o and harmful use diagnoses; measure quantity and frequency of recent drug use, w/c directly translate into variations in clt's clinical status TCUDS - Texas Christian University Drug Screen - this instrument is able to distinguish between individuals with drug use d/o vs those who misuse drugs byt are ot physically and psychologically dependent; 25 questions adminstered in <5 mins; for adults and those in criminal justice sys TCUDS II - 15 - item screening tool as designed to identify any current hx of heavy drug use or dependency; designed to meet criteria in DSM and NIMH Diagnotic Interview Schedule (NIMH

DISC); 2 parts, 1st assessing durg and alcohol use problems and 2nd address frequency of use and the individual's readiness for treatment; can also be self-administered How is physiological drug dependence determined? - tolerance/withdrawal sx Tolerance - there is a need for significantly more of the involved substance to achieve a desired effect or intoxication or if the effects of the substance are significantly diminished when the same amt of substance is used Withdrawal - the discomfort and distress that follow discontinuing the use of an addictive drug Early remission (DSM) - no stimulant use criteria being met (except for craiving) for at least 3 but <12 mos Sustained remission (DSM) - no stimulant use criteria being met (except for cravings) for 12 mos or longer T/F: The terms full and partial are still used to describe remission (DSM specifier) - False; early and sustained only Dual relationship - refers to any situation where multiple roles exist between a therapist and a client. Examples of dual relationships are when the client is also a student, friend, family member, employee or business associate of the therapist. How is gift viewed in therapeutic relationship? - it is acceptable <$20, and gift can be shared by all staff or clients; it may culturally significant. In some cultures, failure to accept gift from clients may lead to termination of treatment; inappropriate gifts (too personal, too costly, or offered in exchange for favors, etc) should be tactfully and politely refused, citing program rules can help to explain and prevent problems and be reported to supervisor and entered into case record. How is dating addressed in treatment if both individuals are clients? - address program policy as dating can undermine treatment; if boundary issues occur, both clients can be separated (one in group and one individual counseling); both need to sign recomittment contracts and renewed abstinence contract may be needed if mutual substance abuse occur T/F It is appropriate for the counselor to also be the client's sponsor in 12-step. - False; due to multiple roles, counselor will have to find a separate mutual self-help program 12 step facilitation approach - involve a thorough introduction to 12-step principles, education about the disease of alcoholism(other drugs), and strong encouragement toward participation in 12-step program

12 step program - based on the philosophy that total abstinence is essential and that alcoholics need the help and support of others to maintain sobriety Step 1 AA - We admitted we were powerless over alcohol and that our lives had become unmanageable. Step 2 AA - Came to believe that a Power greater than ourselves could restore us to sanity. Step 3 AA - Made a decision to turn our will and our lives over to the care of God as we understood Him. Step 4 AA - Made a searching and fearless moral inventory of ourselves. Step 5 AA - Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. Step 6 AA - Were entirely ready to have God remove all these defects of character. Step 7 AA - Humbly asked Him to remove our shortcomings. Step 8 AA - Made a list of all persons we had harmed, and became willing to make amends to them all. Step 9 AA - Made direct amends to such people wherever possible, except when to do so would injure them or others. Step 10 AA - Continued to take personal inventory and when we were wrong promptly admitted it. Step 11 AA - Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out. Step 12 AA - Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs. therapeutic community - drug-free treatment settings providing intensive and comprehensive treatment; goal is to produce a holistically healthy lifestyle; whole community as therapeutic agent Between Cognitive-behavioral coping skills therapy, motivational enhancement therapy, and 12 - step facilitation, which showed a measurable advantage when CLTs were followed for 3 years post tx? - 12 - step

T/F Early therapeutic community utilized punitive contracts, privilege losses, and extreme peer pressure to produce change. - True, but more harsh aspect has been modified except peer pressure as key motivator for change Habilitation vs. Rehabilitation - Habilitation helps clients learn new skills they never had; Rehabilitation refers to the recovery of skills and abilities they have been lost T/F: Research have shown a significant difference between TC (Therapeutic Community) in residential vs day-only TX program. - False, there's no significant difference; TC tx is correlated with measurably positive outcomes; appears to be effective approach to reducing substance abuse, criminal activity, depression, and unemployment among individuals with positive criminal and drug use hx What is the key feature of TC and it's benefits? - structured programming, help clts learn to avoid chaotic lifestyles and focus on daily activities that prevent the boredom and negative thinking that accompanies relapse. Matrix Model - aka Neurobehavioral tx, formulated during 80s spike in cocaine and methamphetamine abuse; utilizes complementary set of eviden-based practices coordinated ad delivered as a program; based on CBT MI, relapse prevention literature, education support, 12- step program Community Reinforcement Approach treatment intervention - comprehensive behavioral program for treating substance-abuse problems. It is based on the belief that environmental contingencies can play a powerful role in encouraging or discouraging drinking or drug use. Consequently, it utilizes social, recreational, familial, and vocational reinforcers to assist consumers in the recovery process. Its goal is to make a sober lifestyle more rewarding than the use of substances. Contingency Management therapy - a therapeutic approach used in the treatment of drug addiction that works to reduce the use of drugs through a highly structured reinforcement and punishment program; provides tangible reinforcement for positive behavior change, including abstinence from drugs and alcohol, and is usually added to another treatment intervention in order to enhance its efficacy. Tangible reinforcements employed in contingency management interventions include vouchers exchangeable for retail goods and services or opportunities to win prizes Integrated Treatment Approach - When mental illness and substance abuse disorders coexist, both diagnoses should be considered primary and simultaneous primary treatment for both disorders is required. 4 Categories of SAMHSA's (Substance Abuse and Mental Health Services Administration) Service Coordination Framework for Co-Occurring D/O - CAT 1 - mental d/o, less severe + substance use d/o, less severe; locus of care is a primary health care setting

CAT 2 - mental d/o, more severe + substance use d/o less severe; locus of care is a mental health system CAT 3 - mental d/o, less severe + substance use d/o more severe; locus of care is a substance use treatment system CAT 4 - mental d/o more severe + substance use d/o more severe; locus of care is state hospitals, jails/prison, ER... What is the most impt variable when assessing for co-occurring d/o? - alcohol/drug toxicity or withdrawal sx as these can present as psychiatric d/o; true psychiatric sx become apparent during the early stages of abstinence T/F: Substance abuse treatment programs for adults and adolescents are the same. - False; due to the physical/psychological/cognitive differences between these 2 population; onset of substance abuse in adolescents is frequently associated with family dysfunction, parental substance use, per influence, and troubled personal choices When working with an adolescent with substance abuse d/o, what is the most appropriate therapeutic approach? - family therapy; these theory believes that conditions leading to adolescent drug use began in the home so family can help with recovery Adolescent community reinforcement approach - focuses on altering environmental influences that perpetuate substance use while also teaching enhanced coping skills for better self- management. Family Intervention Programs - focuses on family and other systems that affect the family (e.g., schools and the community). iy partners a family therapist with a community resource specialist address key family issues that arise when an adolescent uses subtance. Maslow's Hierarchy of Needs - (level 1) Physiological Needs (level 2) Safety and Security (level 3) Relationships, Love and Affection (level 4) Self Esteem (level 5) Self Actualization 50% - percentage of hereditary traits that account for an individual's risk for drug abuse 4 months - after how many months benzodiazepines are ineffective in treating anxiety what is the 2nd-leading cause of drug-related emergency dept admission - Benzodiazepines OD out of all the drugs of abuse, what is the most dangerous to the developing fetus? - alcohol Nootropics - drugs designed to boost cognitive performance; Provigil, Adderall, Piracetam

HFA, High functioning alcoholics - those who are able to compartmentalize their alcohol use and function socially but poorly privately and intimately 5 Stages of Heroin Addiction - 1. experimentation

2. initiation
3. commitment
4. disjunction
5. maturation Experimentation (Heroin Addiction) - dabbling in many drugs, including snorting or subcutaneous heroin injections initiation (heroin addiction) - typically unpleasant 1st experience followed by increasing enjoyable subsequent injections commitment (heroin addiction) - assuming the identity of heroin subculture and orienting life toward habit maintenance disjunction (heroin addiction) - crime, arrests, imprisonment, court-ordered tx, efforts to reduce habit to manageable extent or deal with physical illness and compromise maturation (heroin addiction) - phasing out drugs or drying from abuse Stages of Cocaine Abuse - Experimental Compulsive Dysfunctional Symptoms of metabolic steroid withdrawal are similar to what other type of drug of abuse? - Cocaine; insomnia, anorexia, headaches, restlessness, poor libido, and dysphoria. depressive sx can lead to suicidality What is the suicide risk for individuals treated for alcohol use d/o? - 10x as high among the gen pop. SASSI - Substance Abuse Subtle Screening Inventory +brief, easily administered psychological questionnaire +good for diverse cultures +effective in identifying early stage users who are in denial or concealing Treatment sequencing - prioritizing client needs in the treatment process; requires case management care model CUAD - Chemical Use, Abuse, and Dependence Scale

• used in substance abuse assessment and derives a DSM diagnosis of SUD.
• best known for assessing substance abuse in mentally ill clts SCL- 90 - R - Symptom CHecklist- 90 - R
• assess broad range of psychological problems and key sx of psychopathology
• measure clt progress or tx outcomes COPES scale - Community Oriented Programs Environment
• measure the clients and staff perception of actual, preferred, and expected tx environment or social climate of community tx programs TSR - Treatment Services Review
• designed with ASI
• assess the nature and frequency of tx services provided for a clt in 6 domains: 1) medical 2) substance use 3) employment and support 4) family 5) legal 6)psychological or emotional BIRP - Behavior, Intervention, Response, Plan
• focused on counselor observations and client statements CHEAP progress note - Chief Complaint, Hx, Exam, Assessment, Plan CART and CHART - progress note formats Condition, Action, Response, Treatment plan Condition, Historical significance, Action, Response, Treatment plan What are the medications use to treatment for alcohol dependence? - Disulfiram (Antabuse) Naltrexone (ReVia) Acamprosate (Campral)