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Objectives
• Identify substance abuse/dependence in clients and provide a motivational
• Interview.
• Apply motivational Interviewing in their daily practice.
• Integrate motivational interviewing into any existing substance abuse
• assessments.
Topics
• Addiction/Substance abuse…. What is it?
• Motivational Interviewing
• Withdrawals
• Treatment
What is Addiction/Substance Abuse?
• Disease model • A behavior that persists even though there
is apparent risk or harm to oneself or others (consequences)
• To an outside observer the individual demonstrates diminished, but retrievable, capacity for self-regulation of the behavior
• Life for the individual has become unmanageable
Motivational InterviewingProfessor William R Miller, Ph.D. and Professor
Stephen Rollnick, Ph.D.
• Meeting patient “Where they Are”• Ask, listen, inform• Express empathy• Develop discrepancy• Roll with resistance • Support self efficacy • Ask open ended questions• Listen reflectively • Affirm & summarize • Elicit change talk
Three stage process
• Pre-contemplation stage
Not thinking about change
• Contemplation stage
Thinking about it
• Action and maintenance stages
Ready for action/made change
Adolescents
• Decision made by an authority figure
• Readiness to change
• No Diagnosis
• Parents concern vs. clients
Substance Abuse
• A maladaptive pattern of substance use leading to clinically significant impairment or distress
• Missing obligations
• Hazardous situations
• Legal problems
• Continued use despite consequences
Substance Dependence
• Tolerance
• Withdrawal
• Cannot cut down
• Larger and larger amounts
• Continued use despite consequences
Brief Interventions
• Increasing insight and awareness
• Motivation toward behavioral change
• Drawing out rather than imposing ideas
• Empowering to the individual
• No judgment
• No right or wrong
• Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Meeting patient “Where they Are”
• Does the client want to stop?
• Skip the diagnosis
• Brief interventions
• Denial, anger and refusal of treatment by the client
• No challenging, opposing or criticizing
• “Would you be open/willing to…?”
Express Empathy
• “This must be very hard”
• Careful with “I” statements
• Does not mean agree
• What makes sense to the client may not make sense to you
• Come back to this stage when met with Resistance
Develop Discrepancy
• I’m confused
• Motivation for change happens when a person recognizes a difference between their present behavior and important personal goals
• Help client to recognize ambivalence
• Reflective statements
Affirm & Summarize
• Encourage and praise seemingly small accomplishments
• “What I’m hearing you say is…”
• Longest amount of “clean” time
• Perfect world scenario
• No judgment or tone
Elicit Change Talk
• Increase rapport and commitment to change from clients
• Not necessary to admit to or acknowledge having substance abuse problems
• Readiness to change
• What addiction means to them
• Open-ended questions
• Active listening
Withdrawals
• Alcohol withdrawal syndrome– barbiturates and clonidine– Can be fatal
• Barbiturates and Benzodiazepines – reducing in steps of 10% every 2–4
weeks depending on the severity of the dependency and the patient's response to reductions
– Can be fatal
Withdrawals
• Opiates -Fentanyl -Morphine -Vicodin (hydrocodone) -Oxycontin -Oxycodone -Codeine -Methadone
• Nicotine• Benzodiazepines(can be fatal)
Symptoms
• Dysphoria• Depression • Anxiety• Craving• Seizures• Hallucinations• Tremors• Paranoia• Fatigue• Flu-like symptoms
Symptoms
• Nausea• Sweating• Sleep disturbance• Vomiting• Reduced sensory threshold • Headache• Palpitations• Diarrhea • Weakness• Agitation
Treatment
• Patient can only receive treatment if they are ready
• Pharmacological Interventions
• Prevention/Education
• Community reinforcement approach
• Contingency management strategies
• Inpatient/Outpatient
Anonymous Programs
“God grant me the serenity to accept the things I cannot change; courage to change the things I can;
and wisdom to know the difference.”