Addiction Exam 2 Notecards (#2)

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1

________________ is the beginning of the counseling relationship

assessment

2

person-centered care

  • Change is self- change; people are experts on themselves
  • People have their own strengths, motivations, and resources, which are vital for change to occur
  • Change requires a partnership
  • important to understand the person’s perspective
  • Change is not a power struggle
  • Motivation evoked
  • Cannot take away people’s choice about their behavior
3

PACE

  • part of MI
  • P-Partnership- work with client (you don’t do something to you client but with them)
  • A-Acceptance- profoundly accepting where they are in stages of change
  • C-Compassion- welfare and best interest of the client
  • E-Evocation- you have what you need and we’re going to bring it forth from you
4

Common traps

  1. assessment
  2. expert
  3. premature focus
  4. labeling
  5. blaming
  6. chat
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assessment trap

idea that you need to know/get a ton of info before you can start helping

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expert trap

I am the expert and you are the passive client. Limits opportunity to listen for change talk.

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premature focus trap

confirmation bias. And prematurely focusing on just that. Takes control from client

8

labeling trap

type of premature focus; putting a label on it. “You are a___” or “You have ____”. Client can disagree with your label and then suddenly they are in denial

9

blaming trap

society, others, etc rather than placing an appropriate amount of blame on self

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Ambivalence and the Righting Reflex

  • People have reason to change and to not change at the SAME time. This is normal.
  • Sustained talk- reasons to stay the same
  • Evocation talk- reasons to change
  • Person must build their argument for change… we must be careful not to tell them the “right” thing to do(righting reflex)
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sustained talk vs evocation talk

  • Sustained talk- reasons to stay the same
  • Evocation talk- reasons to change. We focus here
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screening

  • Determining whether there might be a problem
  • Process of assessing risk
  • Detection
  • Case ID
  • Response= YES or NO
  • If Yes, proceed to assessment
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purpose of screening

  • Valid screening when used correcting signals the need for more careful eval and clinical confirmation of diagnosis. It does not itself serve or replace these functions
  • A test score by itself does not establish whether the individual does or does not have an SED
  • **we prefer false positives= we over assess so we don’t miss anyone rather than missing someone who actually has a problem
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sensitive vs specific

sensitive (assessments)- there are few false negatives. This means that we are NOT missing people who present with SUD

specific- means that there are few false positive results. This means that we will likely be missing people who actually do have SUD

Keep in mind that we PREFER MORE false positive bc this means we ARE NOT missing anyone who may be presenting with SUDs.

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Guidelines for Presenting Screening

  • Clear instructions
  • Accurately assure privacy and confidentiality
  • Clarify that screening is a routine procedure
  • Listen to and reflect concerns that are raised
  • Answer the person’s questions clearly and honestly
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the core of the screening process is_____

the clinical interview with the client

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CAGE

  • a standard set of questions you can use!! Used to screen for alcohol use**
    • C-Cut down on use?
    • A- Annoyed when someone has criticized your use?
    • G- Guilty about your use?
    • E- Do you use substances as an Eyeopener in the morning to jumpstart your day?
    • If you say yes to all of these, research indicates it is virtually diagnostic**
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CAGE- AID questionnaire

CAGE but with substance and alcohol incorporated into it

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TWEAK

  • developed for a tool to use for women (initially for drinking during pregnancy)
    • T-Tolerance- how many drinks can you hold
    • W-Worried- have close friends/ relatives worried about your use?
    • E- Eye opener- Do you sometimes use int eh morning when you first get up?
    • A- Amnesia (blackouts) - has a friend/ family member ever told you about this you said/ did while you were drinking that you couldn’t remember?
    • K- K/Cut down - do you sometimes feel the need to cut down your use?
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Questionnaires often used to screen

  • AUDIT and AUDIT ID- for alcohol and substance
  • DUDIT- for illicit substances
  • NM-ASSIST- medical screening in medical settings
  • these take a lot of time though
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ASAM

american society of addiction medicine

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ASAM dimensions

  1. acute intox and/or withdrawal
  2. biomedical conditions and complications
  3. emotional, behavioral, or cognitive complications
  4. readiness to change
  5. relapse, continued use, or continued problem potential
  6. recovery/ living environment
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Dimension 1

  • acute intox and or withdrawal
  • Consider current symptoms and the substance used
  • withdrawal assessment
  • withdrawal managemnent
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dimension 2

  • biomedical conditions and complications
  • current physical illnesses (communicable diseases and pregnancy)
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Dimension 3

  • emotional, behavioral, or cognitive conditions or complications
  • current mental health and psychiatric illnesses.
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dimension 4

  • readiness to change
  • stages of change
  • patient aware of the relationship between seeking reward and the negative life effects
  • continuum of care
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dimension 5

  • relapse, continued use, or continued problem potential
  • is patient in immediate danger of returning to use. What skills do they have to prevent this
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dimension 6

  • recovery, living environment
  • so family members, environments, and other people pose a threat to their recovery and continued recovery
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stages of change

  1. precontemplation (concerned about need)
  2. contemplation (convinced and decision to change)
  3. preparation (create/ commit to a plan)
  4. action (carry out plan)
  5. maintenance (consolidate thechange)
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types of continuum of care

  1. palliative
  2. stabilization
  3. rehabilitation
  4. maintenance
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palliative care

  • relieving immediate symptoms, reducing risk of illness, harm, death; establishing connection with treatment system
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stabilization care

= detox or withdrawal management; enhance retention in care; address medical and welfare needs

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rehabilitation care

  • to make stable again; active tx; provision of range of service
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maintenance care

promoting continued improvement

35

purpose of biopsychosocial assessment

  1. gather info to determine diagnosis, level of care, and other needed services
  2. gather bakcgroundinfo to inform tx
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Aspects of the multidimensional risk profile

  1. Here and now- current signs, symptoms
  2. History—signs, symptoms and tx
  3. How worried now
    • Combo of these 3 guides clinician in presenting the severity and level of function profile
37

ASAM severity

ranges 0-4

0-non issue or very low risk of issue

4- utmost severity rating. impairment in functioning

38

9 DSM disorder classes/ categories of substances

  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogens: PCP, ketamine and other
  • Inhalants
  • Opioids
  • Sedatives, hypnotics, or anxiolytics
  • Stimulants
  • tobacco
  • An “other” or unknown category (10th category): steroids, nitrous oxide, nitrites
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Substance-related dx

  • Substance use disorders
  • Substance-induced disorders
    • Substance intoxication
    • Substance withdrawal
    • Substance/ medication- induced mental disorders
40

Non-substance related dx

  • Gambling disorder
  • Online gaming disorder (not yet in DSM)
41

severity rating in DSM

  • Mild- presence of 2-3 symptoms/ criteria
  • Moderate- presence of 4-5 symptoms/ criteria
  • Severe- presence of 6+ symptoms/ criteria
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Problem statement

  • used for treatment planning with ASAM
  • Describe problem or barrier to that dimension, reflecting data that support that the ASAM criteria is met
  • Describe specific behavior that manifest the problem
  • clients POV
43

goals

  • aspect of tx planning
  • Derived from the problem statement
  • What behavior does the client want to be able to demonstrate
  • Indicates what the client will be able to do when the problem is resolved (discharged criteria)
  • written in client's language
44

guidelines to setting and creating goals

  • ARMS
    • Achievable= possible and realistic
    • Rewarding= wants, worth it
    • Measurable
    • Specific = clear and targeted
  • (or SMART goals)
45

interventions in tx planning

  • What the clinician will do/ provide
  • Context: activities, groups, lectures, individual sessions
  • How the activity will serve the objective