Substance use in social work

dispositional model of addiction beliefs

primary cause of addiction is within the person and under their control. addiction is a brain disease. favors human treatment.

agent model of addiction

emphasis on strong effects of the drug itself, implicit in war on drugs

public health model of addiction

three factors, agent, host, environment, and their actions cause addiction

social learning model of addiction

our experiences shape addiction and we can learn to modify our choices and use of substances. uses conditioning.

personal responsibility model of addiction

failure of self control or violation of moral/religious standards. emphasis on spiritual factors.

sociocultural model of addiction

influences of societal and cultural factors like availability, price, and advertising

four processes of MI

engaging, focusing, evoking, planning

engaging phase of MI

continual process of building trust and working alliance

example of engaging phase

focus on supporting autonomy, enrolling client in services

focusing phase of MI

collaborative determination of what the agenda and goals will be

example of focusing phase

agenda mapping, creating brief action plan

evoking phase of MI

emphasis on recognizing and amplifying client change talk

planning phase of MI

sharing information or proving advice with permission, ask-tell-ask framework

Ask-tell-ask MI framework

ask about client knowledge and permission to share information. Share and then check understanding.

scaling question to assess client’s perceived level of importance for changing the behavior

to help me get a better idea of where you stand, where on a scale of one to ten, one being none, where do you stand on being ready to make a change? and then we can explore why you feel that way

solution focused scaling question

if you are at a 9/10, what could we do right now that would take it down to an 8/10?

exception question

during this time of feeling miserable, were there any times you didn’t feel so bad? What was different then?

peak stimulant use

at lower doses the individual feels less anxiety and mild euphoria

valley stimulant use

at higher or repeated doses, user may have paranoia and delusion

peak cannabis use

cognitive processes are loosened by the THC leading to less controlled and more unusual mental associations

valley cannabis use

discomfort, insomnia, anxiety, restless, irritable, nausea

peak sedative use

lower doses reduce anxiety and include mild euphoria

valley sedative use

agitation, unpleasant arousal, insomnia, headache, sweating, life threatening

peak opiate use

euphoric sense of well being, drowsiness, pain relief

valley opiate use

discomfort, rarely life-threatening

peak psychedelic use

loss of control, dream like state, distortions, hallucinations, disorientation, amnesia

valley psychedelic use

little to no withdrawal, gradual return of mental function

problem recognition question to elicit self motivational statement

what aspects make you think that this is a problem?

concern question to elicit self motivational statement

in what ways might this concern you?

querying extremes question to elicit self motivational statement

how will things look a year from now if nothing changes?

preparation

taken action or generally has a plan of action

contemplation

weighing pros and cons of change and staying the same, ambivalent due to fear of failure or are not convinced they want change

six MET strategies

expression of empathy, developing discrepancy, avoiding argumentation, rolling with resistance, normalize ambivalence, support self efficacy

example of rolling with resistance

you are the expert of your own experience and I am here to listen to what you have to say about your experiences

reframe a client using substances as a reward

you may have a need to reward yourself due to getting through a stressful period

reframe a client drinking as an adaptive function

your drinking can be viewed as a means to avoid tension at home

strengths based culturally responsive question to ask during treatment intake assessment

what is a part of you that you really identify with or are proud of that you think is important for me to know

stigma question

have you experienced any stigma relating to treatment in the past

reflection

say what you think the client means

validate a client thinking therapy doesn’t work

yeah a lot of people have a hard time finding a therapist that isn’t the right fit

step one of NIAAA workflow

screen for heavy drinking using AUDIT-C

step two of NIAAA workflow

advise or assess

if a client screens negative for heavy drinking…

advise to stay within US dietary guidelines

if a client screens positive for heavy drinking…

assess for AUD with symptom checklist and learn drinking pattern

step three of NIAAA workflow

brief intervention tailored to AUD or not

ASAM safety related questions

what does the environment look like for your recovery?

what is a mindfulness based intervention for a client having difficulty managing triggers

working on stress tolerance, disrupting the cycle by learning to let go of fixations and desires

SAMSHA’s 8 dimensions of wellness

emotional, environmental, financial, intellectual, occupational, physical, social, spiritual

medication for OUD withdrawal symptoms

clonidine

medication for alcohol euphoria

naltrexone

medication for opioid OD

naloxone

medication for AUD (aversive)

disulfiram

medication for AUD (after abstinence)

acamprosate

medication for TUD craving decreasing

bupropion

CRAFT model supporting CSO

engaging in meaningful activities and changing the environment

ethical principles

beneficence, non maliience, justice

beneficence

promote client welfare

violation of beneficence

when treatment services are not evidence based and harmful to clients

non malfience

don’t cause harm by action or inaction

justice

effective treatment should be available to those who need it no matter what

harm reduction education jumpstart

providing information on the combined effects of dangerous substance combinations

four phases of SU treatment

palliative care, stabilization, rehabilitation, maintenance

palliative care

keep client in contact with care, reduce risks of harm, increase motivation

stabilization

detox, attention to basic needs, get medically and situationally safe for treatment

rehabilitation

change prior pattern of use

maintenance

sustain change and prevent resumed use long term

ways clinicians can build on client wisdom during maintenance phase

attention to client as expert, elicit their thoughts and ideas on what would work best for them

treatment strategies for pre contemplation stage

consciousness raising and MI

treatment strategies for contemplation stage

MI targeted at ambivalence and decisional balance activities

treatment strategies for preparation stage

collaborative goal and action planning, commitment strengthening