substance use final

dispositional model

primary cause of addicition is within the person and is under their willful control

agent model

addiction results from substances (agents) that drive behavior

public health model

substance use is a complex health issue influenced by multiple factors, focus on harm reduction & prevention

social learning model

our expeirences shape addiction; we can learn to modify our choices & use of substances

focusing (MI process)

involves identifying client goals & priorities, agenda mapping, & creating a brief action plan

evoking (MI process)

involves listening for change talk, investigating client’s inner reasons for change, helping client vocalize what they want to improve

engaging (MI process)

involves building rapport, active listening, making client feel welcome & understood

After completing a ‘Change Plan Worksheet’ with the client, what is a scaling question that you could ask to assess the client’s perceived level of importance for changing the behavior?

On a scale from 1-10, how necessary do you feel it is to make this change? 1 being not necessary at all and 10 being I feel like I need to start right now

What is an indicator of the peak of stimulant use?

at lower doses, the individual feels less anxiety & mild euphoria

what is an indicator of the peak of cannabis use?

cognitive processes are loosened by the THC leading to less control and more unusal mental associations

What question might you ask a client to elicit a self-motivational statement - problem recognition

What makes you feel you might be ready to make this change?

How has this been affecting your daily life?

What question might you ask a client to elicit a self-motivational statement - concern

What do you think might happen if things do not change?

What worries you most about this?

What question might you ask a client to elicit a self-motivational statement - querying extremes

What are the best things that you think could happen as a result of changing?

What are the worst things you think could happen as a result of changing?

contemplation (stage of change)

a client may be weighing pros & cons of changing or staying the same because they fear failure, client not convinced change is what they really want

preparation (stage of change)

client has intention of changing a behavior, but has not taken steps yet

action (stage of change)

client has taken some significant action within the preceading year or generally has a plan of action

precontemplation (stage of change)

client lacks awareness of problem & has no intention of changing

Based on the contemplation stage of change, what are two treatment strategies would you use to help the client enter the change process?

weighing pros & cons of change, elicit self-motivational statements of intent and commitment to change

Based on the preparation stage of change, what two treatment strategies would you use to help support the client in their change process?

offering a menu of options for change & clairfying the client’s own goals and strategies for change

Based on the precontemplation stage of change, what are two treatment strategies would you use to help the client enter the change process?

psychoeducation about the problem & examining discrepancies in the client’s & others’ perception of the problem

One of the six motivational enhancement therapeutic strategies is rolling with resistance. Give an example of what you might say to a client who states, ‘Who are you to judge me or my life, or to tell me that I have a problem?’

You are right, I am not here to judge you. Only you can determine what is a problem in your life.

How might you use the MET strategy of reframing with a client who is using substances as a reward?

You may need to reward yourself with something fun on the weekends for making it through a stressful week.

Multicultural Humility: What is a strength-based culturally responsive question that you could ask a client during an outpatient treatment intake assessment?

What traditions or values help you hold strong in life during tough times?

What is a question that you might ask a client to understand their possible experiences of internalized stigma?

How do you yourself feel about the problem?

In the past, have you felt judged due to your problem?

Provide a simple or complex reflection to the client’s statement: ‘I’m tired of everyone thinking that they know more than me, and want to tell me what I have to do!”

I understand that you feel frustrated with not feeling in control of your own life.

What can you say to validate or reflect the client’s statement: “Therapy is a waste of time. I’ve been to therapy a bunch of times before and it did’nt help at all.”

I can understand why you would not want to come to therapy if it has not felt productive in the past.

You have just provided patient education to a client related to co-occurring PTSD and Opioid Use Disorder. Use the MI framework Ask-Tell-Ask to continue the conversation.

Ask: How do you feel about the information I just shared?

Tell: You’re right, it can sound daunting to treat more than one thing at a time, but it is important to treat them together because the symptoms of the disorders fuel each other. If we were to treat the opioid use disorder without treating the PTSD, there would be a greater risk for relapse in the opioid risk disorder.

Ask: How does this additional information fit in with your goals?

Based on the NIAAA Workflow, what might be a brief intervention to use with someone that has experienced numerous negative consequences from alcohol use or who is not interested in specialized treatment?

advise & assist

Based on the NIAAA workflow, what is the next clinical step to take when a client’s screening scores indicate heavy drinking?

assess

Based on the ASAM Level of Care Assessment, what safety related questions could be asked to get information about the recovery residence?

Do you feel safe in your current living situation?

Do any of your current relationships pose a threat to your safety?

Do you currently live somewhere where others are regularly using alcohol or other drugs?

What is one mindfulness-based intervention that you could use when working with a client that is having difficulty with managing triggers?

diaphragmatic breathing, progressive muscle relaxation

Briefly discuss how SAMSHA’s Eight Dimensions of Wellness could be used as an intervention with clients experiencing co-occurring MH/SUD

it can be used as a holistic framework for clients to identify areas of wellness they would like to improve on.

What is a solution-focused scaling question that you could ask a client that states: ‘This is the worst day of my life?’

If today is at a 10 on a 1-10 scale, 1 being the best and 10 being the worst, what would it take to get to an 8 or 9?

What is a solution focused exception question that you could ask a client that states: ‘I have been completely miserable for the past 8 months!’

Think about just one time you haven’t felt miserable, what was happening?

What is a solution focused goal question tha you could ask a client at the beginning of a therapy session?

What do you feel is most important to work on today?

Which medication might be used to decrease opioid withdrawal symptoms?

clonidine (catapres, kapvay)

which medication can be used to decrease alcohol euphoria?

naltrexone (ReVia)

Based on the CRAFT Model, what would be key areas of therapeutic focus for supporting the concerned significant other (CSO)?

engaging in meaningful activities AND changing the environment

Which ethical principle is violated when treatment services are not evidence-based and are harmful to clients?

beneficence

Which ethical principle states that effective treatment should be available on demand to anyone who wants and needs it without regard to personal characteristics or ability to pay?

justice

Harm reduction: What types of patient education might you provide to an individual that has been using multiple substances?

I would provide information that when we use more than one substance at a time, the substances can interact negatively in our bodies, causing harm, illness, or even death in some cases. I could also provide information on how to get safe supplies for the substances that they are using.

According to the Four Phases of Treatment, what are ways that the clinician can build on the client’s wisdom during the maintenance phase?

The clinician can affirm & supoort the client’s developed self-reliance, validate the client’s knowledge, review the growth the client has made in their treatment process