Assigment .Apa seven . All instructions attached.

Psychotherapy for Clients With Addictive Disorders Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families. Resources Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources. WEEKLY RESOURCES To prepare: Review this week’s Learning Resources and consider the insights they provide about diagnosing and treating addictive disorders. As you watch the 187 Models of Treatment for Addiction video, consider what treatment model you may use the most with clients presenting with addiction. Search the Walden Library databases and choose a research article that discusses a therapeutic approach for treating clients, families, or groups with addictive disorders. The Assignment In a 8- to -slide PowerPoint presentation, address the following. Your title and references slides do not count toward the 5- to 10-slide limit. Provide an overview of the article you selected. What population (individual, group, or family) is under consideration? What was the specific intervention that was used? Is this a new intervention or one that was already studied? What were the author’s claims? Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own clients. If so, how? If not, why? Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article. Use the Notes function of PowerPoint to craft presenter notes to expand upon the content of your slides. Support your response with at least three other peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Provide references to your sources on your last slide. Be sure to include the article you used as the basis for this Assignment.Develop a 8-slide PowerPoint presentation on your selected research article discussing a therapeutic approach for treating clients, families, or groups with addictive disorders.•Provide an overview of the article you selected, including:What population (individual, group, or family) is under consideration?What was the specific intervention that was used? Is this a new intervention or one that was already used?What were the author's claims? 20 to >17.0 pts Excellent 90%–100% The presentation thoroughly and accurately defines the considered population.... The specific intervention used is fully and accurately described. The description clearly indicates whether the intervention is new or whether it was already studied.... The response includes a thorough and accurate description of the author's claims.Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your clients. If so, how? If not, why? 25 to >22.0 pts Excellent 90%–100% The presentation includes a thorough and accurate review of the findings of the selected article.... The response fully addresses whether or not the outcomes will translate into practice with clients. Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article. 25 to >22.0 pts Excellent 90%–100% The presentation includes a thorough and accurate explanation of the whether the limitations of the study might impact your ability to use the findings presented in the article.•Use the Notes function of PowerPoint to craft presenter notes to expand upon the content of your slides. 10 to >8.0 pts Excellent 90%–100% The Notes function of the presentation is appropriately used to comprehensively expand upon the presentation slides.Support your response with at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is scholarly. References are included on your last slide. 10 to >8.0 pts Excellent 90%–100% The presentation is strongly supported with at least three peer-reviewed, evidence-based, scholarly sources. References are included on the last slide.Written Expression and Formatting - Style and Organization: Slides are clear and not overly crowded. Sentences in presenter notes are carefully focused—neither long and rambling nor short and lacking substance. 5 to >4.0 pts Excellent 90%–100% Slides are clear, concise, and visually appealing. Sentences in presenter notes follow writing standards for flow, continuity, and clarity.Written Expression and Formatting - English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts Excellent 90%–100% Uses correct grammar, spelling, and punctuation with no errors.

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Psychotherapy Addiction

Your PowerPoint presentation titled “Psychotherapy for Clients With Addictive Disorders: A Review of Motivational Interviewing in Group Therapy” has been drafted according to your assignment instructions. It includes eight content slides with scholarly, APA 7th edition-formatted references and clear descriptions of the study's population, intervention, findings, limitations, and applicability to practice. Let me know if you need the presenter notes expanded or want the slides exported into a downloadable .pptx file.

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Transcript Search in video Introduction 0:00 AllCEUs.com is your one stop for affordable unlimited CEUs and Addiction Precertification Training 0:10 This episode was pre-recorded as part of a live continuing education webinar. CEUs are still available at ALLCEUs.com 0:32 I'd like to welcome to everybody to today's presentation on the models of treatment. So what we're really going to talk about is some different theoretical 0:40 approaches because not all of us necessarily ascribe to the same 0:46 theoretical approach and when we're working in multidisciplinary teams sometimes we have to think about the different influences from each person in 0:58 that team in order to make a compelling argument for what we want to have happen 1:04 in order to create that win-win situation so that's kind of what we're going to look at today we're going to define the principles of effective Overview 1:12 treatment which hey you know good to know explore current trends and practices in treatment programs and those are rapidly 1:20 changing some of the things that we used to do we don't do anymore and some of 1:26 the things that we haven't been doing we may start doing in the not so distant 1:31 future so I'm going to interject a little bit of new stuff as it relates to the President's Commission on opioid use or whatever it was called that report 1:42 that just came out will identify some common approaches to treatment the main components of each approach we're not gonna go in depth we're just gonna kind 1:50 of hit the highlights like I said so you can figure out if you're working with somebody who uses that theoretical framework how to create a win-win and 1:59 how to work together harmoniously and we're going to compare and contrast each approach a little bit in terms of which clients you might use it with and how it 2:11 might work in different settings such as mental health sandal own private practice versus community behavioral health etc and maybe different ways that 2:20 you might be able to implement it so principles of effective treatment addiction and mental health issues are complex but treatable conditions that Principles of Effective Treatment 2:29 affect the brain the body and behavior so this is one of the new changes and we'll talk about that later but we're really focusing on the whole person 2:39 now we recognize that it's not just the way somebody thinks it's not just their neurotransmitters it is a whole brain body behavior thing and any change in 2:51 any one of these areas can affect the other area so if you start making better behavioral choices then potentially like we talked about yesterday with people 3:01 with alcohol-related brain damage if they make better behavioral choices chances are their brain health is going to improve and their body health will 3:10 improve and their mood theoretically will improve - no single treatment is 3:16 going to be appropriate for everyone so when people come into our clinic or facility or whatever you call the place that you work we can't necessarily 3:25 assume that group 12-step treatment or individual humanistic counseling is 3:33 going to work for them we need to look and say what does this person need now individual humanistic may work in terms of addressing the cognitions and the 3:44 mental health stuff but they also may need some brain body stuff with either a 3:50 psychiatrist or a physician and maybe some social skills or something else so 3:55 we need to look at the comprehensive picture treatment needs to be available 4:00 to be effective and you're thinking well duh but in the big scheme of things when 4:06 we look at how many people actually are able to access treatment only about 10% 4:12 of people with addictions are able to access specialized treatment each year 4:17 and the numbers a little bit higher for mental health but it's not you know wonderful you know less than 50% of people who have treatable mental health 4:28 conditions receive treatment so we want to look at why is that and one of the 4:34 reasons soapbox warning is because treatment is too expensive for a lot of people they have deductibles that are $1,300 and up I look the average 4:45 deductible for a person a single person is $1300 which means insurance doesn't cover anything 4:53 until they pay the first thirteen hundred dollars out of pocket now if a clinician charges a hundred dollars a session that's thirteen sessions which 5:02 could be virtually the entire course of treatment before insurance even kicks in and a lot of people don't have that kind of money just kind of laying around so 5:11 we want to look at the affordability and availability of treatment which is one of the reasons I push groups a lot because groups are a way that we can 5:19 provide a lot of services for affordable amounts for the clients and still you 5:25 know put food on our own tables so looking at how can we as clinicians make 5:31 treatment more available to those in our community virtual services that's 5:37 something that we can look at telemental health so people don't have to get babysitters don't have to travel group therapy having services on the weekends 5:47 or or during the evenings those are always great now you're thinking well that's what I want to be with my family true so it's always a trade-off you got 5:56 to figure out you know could you do evenings two days a week or something in order to be available and that's something that you know is a choice that 6:06 you've got to make on your own I know when we were setting up new programs we would always look at where the demand was where did we have the waiting list 6:15 was it the morning programs or was it the evening programs and you know what kinds of services were in highest demand so effective treatment attends to the 6:25 multiple needs of the individual so we're not just doing that mental health assessment and going okay you've got you need the criteria for major depressive 6:34 disorder so we're gonna treat that and we're going to talk about all the reasons that you're depressed well effective treatment is also going 6:41 to look at their nutrition their social their living environment is their stress their their work environment and you know attending to any medical needs that 6:51 may need to be addressed to also deal with the depression current trends and Current Trends and Practices 6:56 practices focus on the client competencies and strengths instead of saying we're going to get rid of your depression we're going to say we're 7:05 going to help you feel better yeah it's the same thing but instead of getting rid of something we're adding something we're putting something 7:13 awesome in its place and one of the principles of behavior modification is 7:19 that you don't want to just punish a behavior you don't want to just get rid of things because if you get rid of it you have to have something to put in its 7:26 place so too often parents and caregivers and clinicians even sometimes 7:32 will get in the habit of taking away things you know or let's take people they make new year's resolutions I'm gonna stop smoking I am going to stop 7:42 eating sugar I am going to stop doing this and stop doing that well that's just grand but all those things serve a purpose so what are you going to do 7:50 instead and that's one thing that we want to ask what are we working towards what's our goal and what strengths does the person have maybe their social 7:58 skills are weak okay you know maybe they've got a lot of social anxiety that contributes to their other mood issues okay 8:07 well we'll deal with that but let's look at what strengths they have maybe they're really articulate maybe they're really smart maybe they are introverts 8:16 and they just don't really realize that people who are introverted tend to get more stressed out in large groups so we can help educate them about their 8:26 strengths as an individual so we want to focus on strengths and build clients up we want to focus on what's worked in the past instead of saying okay you're in my 8:36 treatment program let's start at square one we're saying okay you're in my treatment program what's worked for you before so let's build this foundation 8:44 and figure out what kinds of tools you already have in your toolbox before we start trying to put more stuff in there and that will also help us figure out 8:53 like I said what's worked before if see cognitive behavioral hasn't worked for 8:58 them before then we don't want to throw a bunch of cognitive behavioral tools in their direction we might ask what about it didn't work for them so we can you 9:09 know make sure that we're going down the right path but we're going to figure out for that person what helps the most and the CBT works well for people who have 9:20 um unhelpful thoughts and cognitions sometimes but sometimes if they've got 9:26 emotional dysregulation they may feel like the clinician just doesn't get how 9:33 intense this is when the clinician says well you just need to change the way you're thinking about things they're like it ain't that easy doc so we want 9:43 to make sure that we provide individualized client centered treatment and shift away from labeling you notice I try really hard not to say addicts 9:53 alcoholics I say people with addictions or addictive issues I try not to say a 10:00 person with depression I try to say a person who has depressive symptoms 10:05 because I want to look at the person I want to emphasize that the person is in 10:11 there and for me when I say a person with depressive symptoms that reminds me 10:17 that depression doesn't look the same for most people you know there there's a 10:22 huge variation and what depression looks like so I want to look at that person 10:28 and what symptoms they're prevent presenting with acceptance of new 10:33 treatment goals other than for example with with substance abuse or addictive 10:39 behaviors abstinence there are some addictions especially the behavioral 10:44 ones but even eating disorders that you cannot completely abstain from you can't 10:50 not eat you could argue the point about sex addiction some people say well you 10:56 don't have to ever have sex you know when we're talking about the totality of 11:01 the human organism that's a choice that each person has to make but those are 11:07 the things that we want to look at in in terms of what is the person willing to 11:12 do and what is going to help them lead the healthiest and happiest life what 11:19 does happiness look like for them for some people you know their definition of 11:24 recovery from depression may be very different from mine but I want to look at what are their treatment goal adoption of a recovery paradigm away 11:36 from problem focused acute care model which means we want to help them figure out how to achieve a rich and meaningful life not just eliminate depression but 11:45 we also want to look at a recovery paradigm a recovery network if you will 11:52 it's not just your symptomatic right now we're gonna treat it right now it'll go away when it comes back you come back for more treatment you know because we 12:01 know that people who have major depressive disorder for example will have recurrences most likely what we're looking at is okay let's treat what 12:09 you've got going on right now let's help you start feeling better and help you continue to feel better ie not relapse and have another episode 12:19 so we want to make sure that we're looking not just at eliminating the present symptoms but keeping them away integration of addiction treatment in Integration of Addiction Treatment 12:28 multiple disciplines especially primary care mental health and addiction so we 12:34 want to make sure that addiction counselors know the basics about working 12:39 with clients with have mental health issues we want to under the primary care physicians have an understanding of how to screen for substance use issues 12:50 evidently less than 20% of primary care physicians ever receive training in that 12:56 that was from the report that came out anyhow and we want to make sure that 13:03 each area is aware of the impact of the other areas so mental health practitioners are aware of the impact of even behavioral addictions like we're 13:13 talking about Internet addiction which is in the dsm-5 and other other sort of sorts of behaviors we also want to make sure 13:22 they're aware of the impact of physiological problems like polycystic ovarian syndrome and hypothyroid okay another trend is the use of 13:31 evidence-based practices and if you are in a clinic you've probably heard about this if you are in individual practice you may not have but I do want to show 13:41 you this really cool little tool and I will deficit by saying evidence-based practices are awesome 13:49 however in many circumstances about 85% of them require you to get go through a 13:57 certain training curriculum or whatever that can be quite expensive which is why 14:03 a lot of agencies have difficulty adopting new EB T's because it requires that every staff member be trained on it and that training is often several 14:12 thousand dollars so the new mandate that we start using that came out that 14:19 treatment facilities start using evidence-based practices well that's wonderful we've been saying that for a long time but how how can we make it 14:30 effective and affordable for agencies to switch over so that being said little soapbox may be a big one the National Registry of evidence-based programs and 14:40 practices by Samsa is great because you can find an intervention search by 14:47 keywords I love databases if you can't tell let's 14:52 look for major depression there we go we're just running a little slow so 15:07 there are two programs that came up in the search results depression prevention managing your mood and partners in care now this shows whether its promises 15:16 promising outcomes or effective outcomes the depression prevention program has 15:23 evident effective outcomes evidence of effective outcomes in research for 15:30 depression and depressive symptoms so you're thinking to yourself well that might be something we want to implement so then you can click on that la dee da 15:40 dee da and learn more about about it how to access that evidence-based practice now let me go back here one more time because I think this is a useful tool 15:51 seeking safety which we're going to talk about later is it an evidence-based practice and that's one you can get relatively inexpensively but you can 16:00 search by program type so let's say a mental health treatment by age let's say 16:07 we're working with adolescents sure why not outcome categories mental health race ethnicity so we're getting to more 16:17 detail about what's going to work with this population let's say Hispanic or Latino and LGBTQ I TS let's just throw that one in there I don't know if we're 16:35 gonna get anything that matches all of those criteria but 16:45 yeah that pushed it over a little bit once I added the special population but 16:51 you can do based on the population you serve you know them best how old are 16:56 they what they're presenting issues are what their gender is what kind of 17:01 setting you have whether it's inpatient outpatient court school or classroom so 17:07 there's a lot of stuff you can look at here and find the different evidence-based practices so ebps are not going away they are really cool they are 17:18 awesome motivational interviewing is an EBP that a lot of us have gotten trained in over the years but you see how many years it took for that to actually get 17:27 completely integrated into practice where most people had had some training 17:33 in it okay use of medications is a new current trend in practice when you read 17:41 a lot of the insurance guidelines for reimbursement on the level of care 17:46 guidelines one of the statements in every single provider that I've ever worked for in the level of care guidelines is medication is used unless 17:58 contraindicated and I mean it may be contraindicated because the person says 18:03 you know I don't want to be on psychotropics or pain meds or whatever it is and that's that's cool but all of the insurance companies that I've ever 18:12 worked with actually have a line item in there that says you need to consider the use of medications for treatment and telehealth technologies are becoming 18:21 huge partly because it makes services more accessible and to a little extent a 18:29 little more affordable you're still paying for the clinicians time and the technology but there are a lot of other ways we can use telehealth such as 18:38 support groups in the rooms is an online chat room for people with substance 18:43 abuse issues people can log into daily virtual support groups or you can even 18:48 host one on your own website if it's a support group you have less HIPAA issues 18:55 especially if you host it on website other than your own you create a secondary arm that's your aftercare support thing talk to your attorney 19:05 about HIPAA and hi-tech confidentiality issues there but there are a lot of 19:10 different things you can do you can provide chat support to your clients so they can get more immediate in the moment support for something that's 19:19 going on maybe there in the first month of recovery you can have forums 19:25 available forums have kind of gone by the wayside over the past 15 years or 19:30 whatever but they still get used some and it allows people to communicate asynchronously and provide each other feedback one that I participate in spark 19:43 people it has an app is a nutrition and health and wellness app but there's a lot of really good interpersonal support that goes on on that in that chat room 19:53 so that's a good place and oh there was another one I met the man the other day 19:58 that created pocket rehab is the name of the app and is only available on Apple 20:05 devices right now but pocket rehab and he has a really great program that 20:11 allows people to both do private journals as well as to receive lifeline 20:16 support from other people who are in recovery and he incorporates all 20:21 addictions not just substances but also shopping and in Internet addiction and 20:28 all those sorts of things so an online video psychoeducation 20:34 if you have certain topics that you teach every single group that comes through like when I when I was at the clinic in South in Florida there were 20:44 certain groups I did every single 30 days so you can record those and it 20:51 doesn't have to be super fancy it can be like this or it can be super fancy whatever you want and have those available online they can be password 20:59 protected so only your clients can get to them if you want to so they can watch them at their leisure and and or you know they can participate in the group 21:08 and then they can go back and review the video later if they need sort of a tune-up so how else can we make treatment more Making Treatment More Available 21:18 available and that's one of the things that's going to kind of plague us because there's the balance between or struggle if you will between making 21:29 services available but we can make them available but we've making them 21:34 affordable is almost more challenging than making them available a lot of 21:40 people kind of shy away from groups especially face-to-face groups because you know they don't necessarily want to see their neighbor when they walk into a 21:49 room online groups have the benefit of people can't see each other or you don't 21:56 have to do video so people can see each other most of the time they can't so people feel like they maintain a little bit more anonymity online services 22:05 that's another thing so I would encourage you to continue to think about that principles of effective treatment duration and treatment for at least Effective Treatment Duration 22:14 three months is generally critical for substances definitely critical for 22:19 mental health you know really 12 weeks is not a long time for somebody who's 22:26 struggling with major depressive disorder you know to really get some traction in their recovery now if you're dealing with some acute adjustment 22:35 issues obviously three months isn't what we're talking about but you know major 22:40 issues that are going on that's really what we want to look at treatment plans must be assessed continually and modified to assure that it meets the 22:48 person's changing needs so you're going along for three weeks and all of a sudden the person loses their job or separates from their spouse or something 22:59 else happens or maybe even they get a promotion at work score that's awesome but you may still need to adjust the treatment plan based on what the 23:09 expectations were for that person to do how much time they have to devote to treatment and the current pressures in their life if they get a promotion then 23:18 they also might have new added stressors if you will of this new job so you might 23:23 have to kind segue over and add that as an additional treatment plan ischium treatment doesn't need to be voluntary to be effective 23:32 what needs to happen is for us to effectively engage the person and 23:37 develop mutually agreeable goals whether you know if they're seeing you for anger 23:42 management issues their boss said they've got to come to counseling for anger management okay well they're probably going to be pretty ticked off 23:49 but they're having to go to these groups I don't blame them so let's talk about 23:54 what is it that you can get out of these groups how might this help you you know 24:00 your goal is to keep your job my goal is to help you with your anger management 24:05 how can we make these two goals kind of work together harmoniously and I used to 24:11 ask my involuntary clients my probation of parole clients what is it that you 24:18 always wanted to learn or what skill or tool might be useful in your life as long as probation and parole is paying for it and you're stuck with me for the 24:27 next 16 weeks what is it that I can help you work on might as well take advantage 24:33 of it because you're stuck with me so that helps a little bit also putting 24:38 the power back in their court and empowering them to identify their treatment goals and let you know again what they're gonna do instead hopefully 24:49 you have the flexibility so if they say I'm not going to 12-step meetings for example you can say okay well you need some you need a support group or you 24:59 need some sort of pro-social activity so many hours a week what are you going to do instead the medical model of treatment looks at these issues mental Medical Model 25:10 health and substance abuse more as a chronic disease issue with mental health 25:15 we're looking at neurotransmitter imbalances with and we also have 25:20 neurotransmitter imbalances with addiction these treatments are often hospital or doctor's office based so you may be working with somebody it's likely 25:28 that you're working with somebody who is also seeing their primary care physician or a psychiatrist for psychotropics okay so if you are 25:38 that's fine but we need to look at it and say okay that person is addressing 25:43 this aspect of the depression or the anxiety or the addiction I'm going to 25:49 address this aspect over here we're not really going to overlap but as the clinician we probably are the single point of contact so we need to make sure 25:58 everything is merging together well the medical model does use a biopsychosocial 26:04 approach with an emphasis placed on physical causes and pharmacotherapy but 26:10 they do look at the psychological and social aspects a little bit and the 26:16 doctor may make some recommendations but he's not gonna do counseling and he's not gonna do life skills training you may see people get detoxification 26:26 medication for symptom reduction medication for a version like antabuse 26:32 which is what they used to give alcoholics and they do still some and medical maintenance or medication assisted therapy the spiritual model Spiritual Model 26:43 views mood issues and addiction as being caused by spiritual emptiness which 26:49 leads to character defects such as pride resentment and anger now the 12-step models are largely based in the spiritual model but you also 26:57 might be working with somebody who's been working with their spiritual guide or their spiritual leader so we want to be able to understand where that person 27:05 has been telling the client this is probably what's causing your your issues right now less weight in the spiritual model is given to causation and more of 27:15 an emphasis is put on a spiritual path to recovery development of values and a sense of meaning and purpose so what we're looking at developing hope faith 27:26 courage discipline those sorts of things which really won't hurt anybody the 27:32 12-step models which are mutual help and many people aren't real familiar with 27:38 twelve steps they've heard about them they know well if somebody has a substance use issue they go to a a or NA well there's a lot of a programs out 27:45 there a lot of Anonymous's they emphasize that one cannot help once 27:51 self and recovery requires surrender of one's will to a higher power now for 27:57 some people as soon as they hear that their skin starts to crawl and they're like oh heck to the no and for other people they embrace that and go you know 28:05 what you're right I've been trying and trying and trying and I can't do it on my own so one of the challenges we have if we're working with somebody who 28:14 either doesn't believe in a higher power or who is angry at their higher power how do we help them embrace that and one tool and I'm going to ask you to think 28:24 about other ways we can help people integrate into 12-step communities if they don't believe in a higher power but one tool that I've always been taught is 28:33 to view God as good orderly direction that is to get to your goals to get a 28:40 reaching meaningful life always think first before you act is what I'm getting 28:46 ready to do going to help me move in a good orderly direction towards my goals or is it gonna you know throw me off track so if we're thinking about good 28:58 orderly direction in terms of a higher power or a higher direction sometimes 29:05 that can help people deal with 12-step meetings if they were a bit resistant 29:11 because sometimes the court just requires 12-step meetings and you can't 29:16 you have no way to get around it you can advocate till you're blue in the face and it ain't gonna help so one thing that I do want to point out with that is 29:26 emotions Anonymous I said there's a lot of eyes out their emotions Anonymous is 29:31 designed for people basically who have emotional dysregulation issues where their emotions they go from 0 to 240 and 1.2 seconds and they feel like they're 29:42 not able to control their anger their depression their anxiety any of those 29:48 dysphoric feelings if they're willing to explore a 12-step sort of approach ei is 29:56 a good activity for them they have their own literature they have their own books the meetings are not nearly as plentiful as 30:05 there are aana meetings around but they're always open to people starting 30:13 new meetings so if you're interested in learning more about it maybe starting a meeting at your facility that could be an avenue that you go down okay so how 30:23 can you use a spiritual model with clients who don't believe in a higher power and for me it comes down to working with them to define what 30:35 spirituality means to them and in what way they think spirituality or lack 30:44 thereof or spiritual roadblocks are contributing to their unhappiness right 30:50 now and so we get into a much more abstract conversation about what's going 30:55 on and talking about what does recovery look like and if you're recovering 31:00 spiritually if you were a coverage spirit spiritually what would be different what do you need to enhance are we talking virtues or what behaviors 31:10 and we kind of pick that apart for a little while to develop their ultimate goal plan Psychological SelfMedication Model 31:27 okay the psychological and self-medication model says that addiction and mental health issues result from deficits in learning 31:35 thinking or emotion regulation so this is the stuff we were all taught in grad school treatments can be ranged from behavioral self-control to individual 31:44 and group counseling to pharmacotherapy I mean we're not opposed to helping 31:52 people figure out what may need to be addressed and advocate for them or 31:59 encourage them to advocate for themselves with their physicians in order to access pharmacotherapy that might help them so the goals will start Behavioral SelfControl 32:09 with behavioral self-control training behavioral self-control is you know think back basic behaviorism strengthen internal mechanisms so increased 32:20 self-awareness of what's going on what you need what your triggers are or your stimuli and establish external controls so you can implement coping skills help 32:32 people start learning how to set goals so they have something out there that they see I need to accomplish this this week or this this month or whatever it 32:40 is and they have this external plan that's helping them monitor and shape 32:48 their behavior you can use behavioral contracting so for example what would 32:54 you contract for with somebody who has major depression who has difficulty getting out of bed we may contract for having the person get up by a certain 33:04 time each day and you put in rewards for achieving that and if they don't achieve 33:11 it then we want to look at you know what what's going on what happened there but each day just like with standard behavioral interventions if they do what 33:21 they're supposed to do or trying to do we need to make sure that it's rewarding so if they do get out of bed at whatever time you you identify 33:31 we need to make sure they have access to some sort of rewards trigger management so encouraging people to be aware of what their triggers are I've told you 33:40 before one of my four as far as mental health mood triggers is the commercials 33:47 for the ASPCA and I was at the gym the other day and I looked up and they had 33:52 this poor little shivering dog in in the video and it just broke my heart I was 33:58 like okay no not even watching that but what are people's triggers for their 34:03 mental health stuff it could be a meeting that they have to go to at work it could be a person it could be a place but helping them identify what those 34:12 triggers are and figuring out how to work with and or through them functional 34:19 analysis of the behaviors not the diagnosis so if somebody has symptoms of 34:25 depression they meet the criteria for major depression whatever you want to say all right we're not going to look at what is the function of depression well 34:34 depression looks different for different people what is the function of not being 34:40 able to get out of bed not feeling you know they just don't want to get out of bed in the morning that's the behavior so what's motivating that well they may 34:49 not be sleeping well they may feel fatigued and exhausted okay let's look at what's causing that because then we can figure out something to address the 34:59 underlying issue that's causing the targeted behavior the behavior you want to eliminate so conducting those functional analyses if somebody stress 35:08 eats okay so that's a specific behavior so what purpose does it serve and what else could you put in its place to satisfy it 35:20 this need instead of stress eating relapse prevention so we want to look at 35:28 relapse prevention strategies for both mental health and addiction and they're basically going to be the same good sleep good nutrition good social support 35:36 mindfulness relaxation and recreation you know regularly I won't say every day 35:42 because some people just they work too jobs have six kids can't do it okay that's fine but we want to make sure that these people are living or trying 35:53 to live a happy healthy life so that's what relapse prevention is is helping the person prevent those conditions prevent it stuff that caused the 36:03 neurochemical imbalances that led to their depression which may have led to 36:08 their unhelpful thinking so you know wherever the unhelpful thinking came in 36:16 the process you know it doesn't really matter we end up needing to treat or address everything but realizing that relapse prevention means preventing 36:25 those conditions from occurring again just like when there's a hurricane there's a certain set of conditions that have to happen for hurricane to form 36:33 well there's a certain set of conditions for each person that need to kind of occur for them to have a recurrence of their major depressive episode in most 36:41 cases like 99% of the cases so we want to know what those are so we can try to 36:46 prevent them and we don't want to know what those are and what the symptoms are 36:52 of the beginning of an episode so people can intervene early if they notice you 36:58 know what I'm starting to feel kind of wonky then they can start saying I need to back off maybe I need to take this weekend off and rest and relax because 37:07 I'm starting to get burned out and I'm starting to feel blue and I really don't want to go into a whole depressive episode that's relapse prevention so 37:16 preventing an early intervention dialectical behavior therapy came as a Dialectical Behavior Therapy 37:22 response to people who weren't doing well with traditional cognitive 37:27 behavioral clients in traditional cognitive behavioral often and traditional therapy often unintentionally reward ineffective 37:35 treatment while punishing therapists for effective therapy with a lot of clients 37:43 when we start digging when we start pushing buttons when we start helping them move through those stuck points it hurts and they don't like it so in 37:53 certain circumstances among certain groups of people they symptoms escalate so much that the therapist has to back off every time 38:01 they start to get to a point the client either discharges or rapidly escalates 38:07 or decompensates so cognitive behavioral wasn't helping to deal with the distress 38:14 that was caused by pushing on those buttons and dealing with those old wounds the sheer volume and severity of problems presented by clients makes it 38:23 impossible to use the standard cognitive behavioral format in many cases because 38:28 they would be doing ABC worksheets until doomsday so we need to help them figure 38:34 out how to moderate some of this distress and how to figure out what the 38:39 root causes are clients found the focus on change inherent to CBT in validating 38:46 because cognitive behavioral was often saying again this is your problem is 38:52 caused by unhelpful cognitions and behaviors that's what you need to change let's you know it's very practical very pragmatic but clients who are struggling 39:01 and who are extremely emotionally raw often felt very invalidated Emotional Dysregulation 39:09 so the overriding themes in DBT our mindfulness using that wise mind getting 39:15 out of the emotional reactive mind distress tolerance sometimes life is 39:21 going to be unpleasant and you can't necessarily make it stop so what do you 39:26 do how can you address it emotion regulation and interpersonal 39:31 effectiveness and problem solving a lot of people who have emotional dysregulation have difficulty managing those emotions and not going from 0 to 39:42 240 and 1.2 seconds they've had struggles with interpersonal 39:48 relationships a lot of people with borderline personality disorder characteristics also struggle with relationships because of their lack of 39:58 internal sense of self their need for external validation so more interpersonal effectiveness skills need to be taught but they also need to be 40:08 able to regulate their emotions and their distress another model that you Matrix Model 40:15 might not be familiar with but has a lot of really awesome units for straight-up 40:21 mental health is the matrix model for stimulant use now if you're going to use it as an evidence-based practice obviously you're using it with stimulant 40:29 abusers but this manual for the matrix model provides you with worksheets I 40:42 mean it's it's a clinicians manual for identifying triggers body chemistry and 40:48 recovery thinking feeling and doing work in recovery guilt and shame sex and 40:55 recovery truthfulness trust being smart not strong talking about asking for help 41:02 so there are a lot of really awesome things that you can get some ideas off 41:07 of to do group if nothing else the goals of the matrix model are to learn about 41:12 issues critical to addiction and relapse receive direction and support from a 41:18 trained therapist and become familiar with self-help programs not just 12-step but that can include celebrate recovery and some of those others the therapist 41:27 functions simultaneously as teacher and coach fostering a positive encouraging relationship so a lot of this is psycho-educational like I said it a lot 41:38 of the groups are applicable to people who don't have any addiction issues at all motivational inherent enhancement Motivational Inherent Enhancement 41:46 therapy is unique because it usually only consists of three to five sessions 41:51 period and a story it's used to help resolve ambivalence about treatment and 41:57 abstinence or change whatever the change may be and that can be relationship 42:02 issues or whatever the therapy consists of initial and assessment battery 42:08 because you want to get an understanding of what's going on in this person's life so you can provide them feedback followed by two to four individual 42:17 sessions with the therapists and they're not usually weekly they're spaced out where you develop goals and you empower the person to make 42:25 Changez on their own the first treatment you want to provide feedback about the First Treatment 42:31 initial assessment place the responsibility for change directly on the shoulders of that person saying you know what you got this but I can't do it 42:40 for you I am here to advise as much as I can but ultimately if you're going to 42:45 change it's the balls in your court so we want to elicit self motivational state statements identifying the reasons they want to do it and examples of how 42:55 they've succeeded in the past so self motivation and self-efficacy we want to strengthen motivation and build a plan for change so this is still the first 43:03 session it's a long one we provide advice such as coping strategies for 43:08 high-risk situations then we provide a menu of options so here's some advice 43:20 about you know different directions you could go here's a menu of options for different types of treatment different books you could read you know these are 43:28 things I think would help you here's a laundry list now let's figure out what looks good to you we want to provide empathy and enhance self efficacy 43:39 so feedback responsibility advice menu of options empathy and self-efficacy in 43:46 the subsequent sessions the therapist monitors change reviews the change strategies being used and encourages change you're the cheerleader at that 43:55 point so this is very behavioral in nature and motivational in nature and 44:02 puts a whole lot of responsibility on the person which means it's really good for some people who are really high functioning and really motivated family Family Behavior Therapy 44:13 behavior therapy I really like it's demonstrates positive results in both adults and adolescents it addresses not only substance use and mental health 44:23 problems but other co-occurring issues because it's family behavior therapy not identified patient behavior therapy so we're looking at a whole family going 44:32 alright what's going on here it can start addressing conduct disorders child mistreatment family console unemployment you know the range of 44:41 things goes on we figure out what are the weak links if you will or the 44:46 trigger points in this family that are causing the identified behaviors what 44:51 they want to get rid of and how can we help them meet those goals it involves 44:57 the patient along with at least one significant other such as a cohabitating partner or a parent so it doesn't have to be the whole family ideally it is 45:06 everybody living in that household but it requires at least one other person 45:12 FBT combines behavioral contracting with contingency management so you set up a 45:17 contract you agree to do these things if you do there are certain rewards that you can get and they set up the rewards therapists seek to engage families in 45:26 applying the behavioral strategies taught in sessions and acquiring new skills to improve the home environment such as you know how do you deal with 45:34 the toddler if you know there are difficulties with child neglect or child maltreatment you know some education about how to do that and okay when Sally 45:44 starts asking why is this blue or why is this green for the 700th time and you 45:50 just want to pull your hair out what do you do instead of losing your temper 45:56 so basically providing these tools but it's set up in a contract with rewards 46:02 for successful completion and it does in contrast to the other things it looks at 46:08 the family system it looks at the environment and addresses biopsychosocial spiritually environmentally the trigger points that 46:17 may be prompting the behaviors you want to eliminate seeking safety love this Present Focus Therapy 46:24 one is a present focus therapy for trauma PTSD and addiction it is available as a book with guidance for clients and clinicians and you can get 46:33 it on Amazon and it can be done in individual or group I had two clinicians 46:38 where I used to work that used to run this program or different instances of this program and the clients loved it and did super super well as far as their 46:49 their outcomes the topics not going to go into huge depth you can look at it on Amazon but they range from introduction to safety Present Focus Therapy Outcomes 47:00 PTSD and taking it taking back your power compassion creating meaning 47:05 detaching from emotional pain and grounding identifying red and green flags and self nurturing and again you can conduct these in any order so your 47:15 particular group may need a different order and maybe you don't work with 47:21 people who have active substance use issues so you can take that substance group kind of out of it because this is really looking at PTSD recovery and 47:30 creating safety the socio-cultural model emphasizes the socialization process SocioCultural Model 47:37 culture observational learning and reinforcement of behaviors so somebody 47:43 using this model is really going to look at the social and family relationships and in substance abuse recovery we often say that people need to change people 47:52 places and things well that's easy to say but it is almost impossible to do 47:58 for most people they're going to go back to that same environment out of which they came because that's the only place they have to go they don't they can't 48:07 afford to go to a sober-living facility that may charge $1500 a month or something so they're going back home so changing the culture that they live in 48:17 they live in the same neighborhood you know whatever that's not so easy but we 48:22 can help them develop skills and tools to deal with the stressors in their 48:27 family and social relationships in their environment we can help them develop 48:32 social competency and interpersonal effectiveness playing on the observational learning if they see John and he's doing he's he goes drinking 48:43 when he's had a bad day and it seems to help him feel better and your client says well maybe I had a when I have a bad day go out drinking we want to 48:51 encourage him to think what are your ultimate goals and is following what John does even though it looks like it might help is that really going to help 48:59 you is that going to be the solution that you're looking and encourage people to work within their own cultural infrastructure to 49:09 find a safe place you know what is it that I can do where so I'm remaining 49:16 true to my culture as I define it but I'm also happy and healthy and all those 49:24 sorts of things relapse prevention is a really basic approach and it adopts strategy is designed to help clients become aware of 49:32 cues or triggers that make them more likely to abuse substances or become 49:37 symptomatic triggers and I've told you before that um you know it can be 49:42 holidays it can be seasons it can be smells it can be there are a variety of 49:48 things I know for me there are certain smells that trigger really positive memories and certain smells that trigger trauma and I've learned how to deal with 49:58 those triggers through practice and experience but it's important for 50:03 clients to be able to recount if they have a smell for example that triggers a 50:09 traumatic memory for them to be able to stay in the present and not you know go 50:14 back there wherever back there was so relapse prevention helps people be a lot 50:22 more cognizant of their environment and more mindful one of the things that we don't we don't usually use the words mindfulness and relapse prevention 50:29 together but you can't have one without the other mindfulness helps clients identify when they start feeling that queasy little 50:39 feeling that pit of their stomach that says this is not a good place for me to be or this is gonna be stressful so they can address it early that early 50:48 intervention and it helps them look around and eliminate as many triggers as possible so they can have positive things around 50:56 if they're say particular you know billboard on their way to work that 51:02 triggers them they can go a different route if they see maybe they're driving past the neighborhood where they used to live with their expose and that just 51:11 devastates them every time they drive by it or it makes them really angry well maybe they can find a different to work so monitoring and managing those 51:20 triggers so they're not intentionally putting themselves in stressful or dangerous high-risk situations and helping them develop alternative coping 51:29 responses to those cues all right so you have to drive by your old neighborhood you get enraged when you drive by there and you're thinking about what happened 51:38 and I can't stand it what can you do how can you get out of that flurry of 51:45 adrenaline and get yourself to a place that's more helpful for you for some 51:52 people you know one thing I might suggest for a client who has to do that is to think alright if they know ahead of time they're gonna have to drive by 52:01 that place what can they do leading up to it positive self-talk leading up to it and distraction techniques as they pass it so maybe having their favorite 52:09 song really loud on the radio or the comedy channel on or something that can 52:15 help so they get so they get past it or if they have an unreasonable fear of bridges what can you do if you know you've got to go over a bridge to get 52:25 through it so it doesn't throw you for for a loop now obviously those are acute responses but enough stressors could potentially 52:35 trigger a full-blown relapse of anxiety or depressive major depressive symptoms Medication Assisted Therapy 52:42 medication assisted therapy which allegedly is supposed to be becoming 52:47 available at all treatment facilities and I'll wait to see that happen 52:54 includes methadone suboxone vivitrol antabuse and some SSRIs you're selective 53:02 serotonin reuptake inhibitors they've been found to help with certain compulsive behaviors certain antidepressants especially zoloft it's 53:12 been found to be really helpful with people with bulimia so there is some evidence out there that SSRIs can help with some compulsive behaviors in 53:20 addition to mood issues vivitrol is helpful for alcohol and opiate abuse 53:29 antabuse is the thing that people take then makes them throw up and really really sick actually it increases the rate at which they get alcohol poisoning 53:38 is technically what happens if they drink so there's a lot of different 53:44 types of medication assisted therapy out there it's not necessarily meant to have somebody on it indefinitely I help start a methadone clinic where I 53:56 came from in Florida and our psychiatrist really looked at it as an 18-month treatment program get people on you know get them to the point where 54:06 they're not having cravings to use then they had in methadone clinics you are required by the Food and Drug not food and drug by the DEA there are all kinds 54:16 of requirements for counseling that have to take place in a methadone clinic not in the patient not in the doctor's offices where people go and get suboxone 54:26 that's generally just getting them suboxone but in methadone clinics people have to undergo pretty intensive therapy in addition to it and a lot of clinics 54:36 will only maintain people on it unless there is an overriding reason not to 54:42 discharge them for about 18 months to two years you have to present to the 54:48 powers that be at the DEA or wherever compelling reasons to keep somebody on 54:54 methadone more than two years now some of the people that I worked with that were veterans did have chronic pain they had opiate addiction issues methadone 55:06 was being used to help monitor manage their pain you know there were some outstanding outliers or whatever but understand that methadone really for the 55:19 most part is not meant to be something that people get on and stay on for the rest of their lives it's not replacing one addiction with another it's supposed 55:27 to help them get through that period until their neurotransmitters can kick back in and they develop the skills they can they need to develop to deal with 55:36 life on life's terms medication assisted therapy for mental health issues are 55:42 your SSRIs SNR is your atypical antipsychotics your antipsychotics some people need those obviously if 55:50 somebody has a psychotic disorder or a bipolar disorder they're probably going 55:56 to have to be on medication people with a generalized anxiety and major depressive disorder and some of your mood disorders may not have to be but it 56:05 may help them get through until they start getting some treatment traction harm reduction is the acceptance that drug use and mental health issues are Harm Reduction 56:14 just a reality the goal is to prevent harm caused by severe mental health 56:20 issues you know not being able to get out of bed losing your job relationship problems you can have a lot of problems from mental health even if you don't 56:29 have an addiction when we talk about these we talked about the for ELLs just to make it easier to remember liver lover livelihood and law so we 56:38 want to prevent health problems we want to prevent relationship problems we want to keep people employed and keep them from getting involved with the law 56:48 interventions for harm reduction include low threshold pharmacological interventions so like what we just talked about if we're talking about 56:58 drugs needle exchange programs emphasis on non injection routes of administration such as oral tablets and even smoking and inhalation but 57:10 injection int'l a ssin and smoking are the three fastest ways to get high and three most potent so we want to steer people away from those as much as 57:18 possible lead more towards oral as as needed and if you've got somebody on 57:24 other medications you know for some sort of mental health issue I know some of my 57:30 clients who had psychotic disorders would have injectable antipsychotics but 57:36 we don't want people ideally injecting themselves every single day unless it's inevitable but with the antipsychotics a once a month injection of the of the 57:49 antipsychotic would keep the person going so they didn't have to remember to take it so we want to look at harm reduction what can we do to help this 57:56 purse an involvement of those with a history of use or distress in program development so to develop a harm 58:04 reduction program we need to ask people who have the problem what is going to help you out what can minimize the ancillary problems caused by this 58:14 behavior condition or addiction multidisciplinary psychotherapeutic Multidisciplinary Interventions 58:21 interventions for co-occurring issues medication assisted therapy for both addictive and mental health issues wraparound services including legal and 58:30 child care and social services to ensure people have access to necessary resources to achieve their goals and family therapy to improve the 58:39 interpersonal environment of the person now if you can get all those in the same facility awesome but these are all things that we need to consider when 58:48 we're looking at providing a comprehensive treatment program there Conclusion 58:53 are many approaches to dealing with mental health and addiction issues since co-occurring issues are the expectation not the exception it makes sense to be 59:01 aware of strategies to address both or all issues or at least where to find those evidence-based and promising practices current trends and practices 59:10 are steering clinicians to use more individualized strengths-based biopsychosocial spiritual approaches are there any questions 59:24 you 59:39 all right everybody you have an amazing day I am going to be doing an extra 59:45 little recording it's not a CEU thing but let's see it's one o'clock now in 59:50 about 30 minutes I'm going to be doing another recording in the same room on 59:55 the recommendations that came out from the opiate Commission thingy so if 1:00:01 you're interested in learning about it you can tune in if you don't want to that's cool too it will be on the YouTube channel on Saturday have a great 1:00:09 weekend everybody if you enjoy this podcast please like and subscribe 1:00:20 either in your podcast player or on YouTube you can attend and participate in our live webinars with doctor Snipes by subscribing at all CEUs comm slash 1:00:29 counselor toolbox this episode has been brought to you in part by all CEUs comm 1:00:34 providing 24/7 multimedia continuing education and pre certification training to counselors therapists and nurses since 2006 use coupon code consular 1:00:45 toolbox to get a 20% discount off your order this month

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