Alcohol and Other Drugs Prevention and Intervention
Slide 2
Prevention Most efforts directed at young people Rates of
alcohol and tobacco use are very high in this group National
Drug-free policies dont include alcohol and tobacco, widely
considered gateway drugs Related to politics not best practice
Slide 3
Prevention Harm Reduction: when it is assumed that SA cannot be
eliminated Types: Needle exchange Sobriety check points Designated
drivers Tobacco Stings
Slide 4
Prevention Supply Vs. Demand 1.7 Billion for war on drugs in 87
1.2 was for supply reduction 1990 committee revealed little
evidence that supply reduction worked 1997 67% for supply
reduction, 33% divided between prevention,Tx, research
Slide 5
Prevention Legalization Extremely controversial Which drugs,
how much, for who, where? Legalization vs. decriminalization Some
drugs are legal (ETOH, Nicotine, RX drugs) Making drugs legal and
unrestricted as opposed to removing penalties for certain drug
related offenses
Slide 6
Prevention Public Health Model (PHM) Focus on epidemiology SA
is conceptualized as an interaction between host (the substance
abuser), the agent ( the substance used), and the environment
Prevention activities are conceptualized as primary, secondary and
tertiary
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Prevention Primary Prevention Attempts to dissuade individuals
from initiating use Secondary Prevention Early intervention,
designed to halt progression in individuals identified as users
Tertiary Prevention Treatment aimed at substance abusers and
substance dependent
Slide 8
Prevention Prevention Efforts Universal Directed at entire
population (national media campaign) Selected targeted at risk
groups (ACOAs) Indicated Similar to secondary prevention
Slide 9
Prevention Prevention Strategies Information dissemination
Education Alternatives Problem identification and referral
Community based processes Environmental approaches
Slide 10
Prevention Few of these prevention strategies have been proven
to impact SA Environmental approaches (deterrence laws, sobriety
checkpoints, bartender training) have proven effectiveness. Usually
rely on community coalitions to implement these strategies
Education works up to three years
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Intervention Why is intervening with SA so challenging? Denial-
a psychological defense, response to assault on ego integrity Fear-
of abandoning a relationship that, while harmful, is at least
familiar. The addict may be immobilized by fear of life without
drugs
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Intervention Intervention (according to Anderson) is the
process of stopping someone who is experiencing the harmful effects
of AOD Johnson Intervention- Based on the disease model asserts
that forcefulness is needed to counter the almost impenetrable
defenses of the victimswhich are organized into highly efficient
denial systems.
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Intervention Johnson Intervention It is a myth that alcoholics
have some spontaneous insight and then seek treatment. Victims of
this disease do not submit to treatment out of spontaneous
insight-typically, in our experience they come to their
recognition...through a buildup of crises that crash through their
almost impenetrable defense systems. They are forced to seek help;
and when they dont, they perish miserably.
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Intervention Johnson Intervention Raise the bottom Serves to
precipitate a crisis that is not life threatening or seriously
damaging Presents reality in opposition to denial Objective,
unequivocal and caring Attacks defenses, not the victim
Slide 15
Intervention Johnson Intervention Process 2 or more people
Sometimes not the closest people Be prepared for client refusal
Rehearse Get professional help Have options arranged!!! Emotionally
charged!!!
Slide 16
Intervention Effectiveness of Coercive Treatment Has a higher
cure rate (Matuschka,85) 97% of the time successful (Royce, 89) 50%
of the time successful (authors)
Slide 17
Intervention Motivational Interviewing (William Miller and
Stephen Rollinick) is a process for assessing a clients readiness
to change and it uses procedures based on this readiness to enhance
the probability of change. In Motivational Interviewing it is
acknowledged that the client may not be ready to benefit from a
direct attack on his or her use of AOD.
Slide 18
Intervention Motivational Interviewing (MI) Confrontational
strategies are not supported by outcome studies. No persuasive
evidence that aggressive tactics are even helpful let alone
superior. Understandable and predictable reactions and resistance
to change cause many counselors to jump to the conclusion that
clients are in denial. This stance elicits further resistance and
denial.
Slide 19
Intervention Stages of Change (Prochaska and DiClemente)
Precontemplation Contemplation Determination Action Maintenance
Relapse
Slide 20
Intervention Stage 1 or 2-contraindicated for use of aggressive
interventions as clients may react with increased resistance Stage
3 or 4-appropriate for aggressive intervention as client is in a
position to react positively Stage 5 or 6- MHP focus on creating an
environment where client can safely discuss difficulties with
behavior change
Slide 21
Intervention MHP should recognize that the stages of change
exist on a continuum and that clients may cycle through them
several times Working through ambivalence- Create an environment of
empathy, respect, warmth, concreteness, congruence, genuineness,
and authenticity
Slide 22
Intervention Traps to Avoid Confrontation- can result in a yes
you are no Im not struggle Question answer trap- avoid closed ended
questions Expert trap- MHP takes role of expert, client avoids
having to make choices Labeling- client may resist diagnosis
Premature focus- focus on AOD before client is ready Blaming-client
feels blamed by MHP
Slide 23
Intervention Strategies for Resolving Ambivalence Open ended
questions reflective listening affirming supportive statements
summarization
Slide 24
Intervention The elicitation of self-motivational statements is
the guiding strategy to help clients resolve their ambivalence. In
MI it is the client who presents argument for change. It is the
counselors task to facilitate the clients expression of these
self-motivational statements.
Slide 25
Intervention Self-motivational Statements Client describes the
pros and cons of SA Asking client what worries you about SA How has
SA been a problem for you? Paradoxical Techniques MHP argues for
continued use while client argues against
Slide 26
Intervention Rolling with Resistance Ambivalence does not
disappear but diminishes Assumption is that client resistance is a
therapist problem Change in resistance is significantly impacted by
therapist attitudes Categories of resistance Arguing, interrupting,
denying, ignoring
Slide 27
Intervention Rolling with Resistance Techniques for reducing
resistance Amplified or double sided reflections Shifting the focus
(redirection) Emphasize personal control and choice Have client
explain the consequences of his or her continued SA Re-framing
Assist the client in viewing the problem from a different
perspective
Slide 28
Intervention Transition From Resistance to Change MHP will be
aware of transition when client Reduces questions about the problem
Seems more calm and settled Makes more self-motivational statements
Asks more questions about change Talks about life after change
Experiments with change
Slide 29
Intervention If the client progresses to the action stage the
emphasis should be on Setting goals considering options to achieve
goals deciding on a plan staying aware of issues that indicate a
return to an earlier stage of change