Residential Treatment
Residential Treatment
Residential Treatment
Module 1:
Drug Addiction and Basic
Counselling Skills
Module 2:
Motivating Clients for Treatment and
Addressing Resistance
Module 3:
Cognitive Behavioural and
Relapse Prevention
Strategies
Workshop 1
Workshop 1
Workshop 1
Workshop 2
Workshop 2
Workshop 2
Workshop 3
Workshop 3
Workshop 3
Workshop 4
Module 1: Workshops
Workshop 1: Biology of Drug Addiction
Workshop 2: Principles of Drug Addiction
Treatment
Workshop 3: Basic Counselling Skills for
Drug Addiction Treatment
Workshop 4: Special Considerations when
Involving Families in Drug
Addiction Treatment
4
15 Min.
Pre-assessment
10 Min.
Training objectives
At the end of this workshop you will be able to:
l
Understand the reasons people start drug
use
l
Identify 3 main defining properties of drug
addiction
l
Identify 3 important concepts in drug
addiction
l
Understand characteristics and effects of
major classes of psychoactive substances
l
Understand why many people dependent on
drugs frequently require treatment
8
Introduction to
Psychoactive Drugs
10
11
12
13
14
What is
Drug Addiction?
15
16
Compulsive behaviour
Behaviour is reinforcing (rewarding or
pleasurable)
Loss of control in limiting intake
17
Important terminology
1.
Psychological craving
2.
Tolerance
3.
Withdrawal symptoms
18
Psychological craving
19
Tolerance
20
Withdrawal
Drug
Categories
22
Stimulants
Hallucinogens
Alcohol
Amphetamines
LSD, DMT
Benzodiazepines
Methamphetamine
Mescaline
Opioids
Cocaine
PCP
Solvents
Nicotine
Ketamine
Barbiturates
Khat
Cannabis (high
doses)
Cannabis (low
doses)
Caffeine
Magic mushrooms
MDMA
MDMA
23
Alcohol
24
25
Withdrawal Symptoms:
Tremors, chills
Cramps
Hallucinations
Convulsions
Delirium tremens
Death
26
27
Tobacco
28
Withdrawal Symptoms:
Cognitive / attention deficits
Sleep disturbance
Increased appetite
Hostility
Irritability
Low energy
Headaches
30
31
Cannabinoids
Marijuana
Hashish
32
Route of administration:
Activity 1
Think of all the names for marijuana in your
community and how this drug is consumed.
34
Relaxation
Increased appetite
Dry mouth
Mood changes
Bloodshot eyes
Impaired memory
Reduced nausea
Increased blood
pressure
Reduced cognitive
capacity
Paranoid ideation
35
Withdrawal Symptoms:
Insomnia
Restlessness
Loss of appetite
Irritability
Sweating
Tremors
Nausea
Diarrhea
36
37
Stimulants
METHAMPHETAMINE
CRACK
COCAINE
38
39
Cocaine
Powder cocaine
(Hydrochloride salt)
Smokeable cocaine
(crack, rock, freebase)
40
Activity 2
What stimulants are used in your community and
how are they consumed?
41
Route of administration:
Smoked, injected, snorted, or administered by mouth
or rectum
42
Acute effects:
Withdrawal symptoms:
45
Meth Mouth
(New York Times, June 11, 2005)
49
Opioids
50
Opioids
Opium
Heroin
Morphine
Codeine
Hydrocodone
Oxycodone
Methadone
Buprenorphine
Thebaine
51
Euphoria
Pain relief
Suppresses cough reflex
Histamine release
Warm flushing of the skin
Dry mouth
Drowsiness and lethargy
Sense of well-being
Depression of the central nervous system
(mental functioning clouded)
53
55
Other drugs
Inhalants
Petroleum products, glue, paint, paint removers
Barbiturates
Steroids
Activity 3
Working individually or in small groups, think of the
drugs that are consumed in your area and the way
they are consumed both by youth and adults:
Introduction to
Addiction and the Brain
58
59
60
61
62
Natural rewards
Food
Water
Sex
Nurturing
63
64
65
66
Control Methamphetamine
(Source: McCann et al. (1998). Journal of Neuroscience, 18, 8417-8422.)
67
Partial Recovery of
Brain Dopamine Transporters in
Methamphetamine (METH) Abuser
After Protracted Abstinence
3
0
ml/gm
Normal Control
METH Abuser
(1 month detox)
METH Abuser
(24 months detox)
DA = Days Abstinent
69
70
?
?
?
Questions?
Comments?
71
72
Workshop 2:
Principles of Drug Addiction Treatment
73
Training objectives
At the end of this workshop you will be able to:
1.
2.
3.
4.
Comprehensive
Treatment
75
family,
76
77
20 Min.
79
Treatment duration
80
behaviour
Degree of support from family and friends
Pressure to stay in treatment from the
82
Medical doctors
Psychiatrists
Psychologists
Social workers
Nurses
Case managers
Certified drug abuse counsellors
Other substance abuse professionals
83
15 Min.
84
85
2.
3.
4.
5.
7.
8.
9.
11.
12.
13.
Recovering from drug addiction can be a LONGTERM PROCESS and frequently requires multiple
episodes of treatment
88
Categories of
Treatment
89
Categories of treatment
Detoxification
Pharmacological treatment
Residential treatment
Outpatient Treatment
90
Medical detoxification
Detoxification is a process where
Pharmacological treatment
92
Residential treatment
93
Focus on re-socialization
94
Outpatient treatment
Recommended elements of outpatient treatment
include the following:
Weekly sessions for around 90-120 days
Family involvement
Positive reinforcement approaches
Cognitive-behavioural materials
12-step meetings or support group participation
Urinalysis and breath alcohol testing
Medication as appropriate
95
Ethical and
Legal Issues
96
Ethical guidelines
Ethical Values:
Be good!
Do good!
And above all: Do no harm!
97
98
professions
99
Professional boundaries
100
Confidentiality (1)
101
Confidentiality (2)
102
15 Min.
103
Be a role model
104
?
?
?
Questions?
Comments?
105
106
Workshop 3:
Basic Counselling Skills for
Drug Addiction Treatment
107
Introduction to
Counselling
109
techniques
Positive reinforcement
Emotional support
Formal record
110
Basic Counselling
Skills
112
PROCESSING
RESPONDING
TEACHING
Active Listening
Active listening
114
of feelings
Summarising
115
Attending (1)
116
Attending (2)
Attending helps the clinician
Attending (3)
Example of attending
Um-hm.
Please
continue...
I see.
I am so tired,
but I cannot
sleepso I
drink some
wine.
When I wake
upit is too late
already
119
15 Min.
120
Paraphrasing (1)
121
Paraphrasing (2)
Paraphrasing helps the clinician
spotlight an issue
122
Example of paraphrasing
My mom irritates me. She
picks on me for no reason
at all. We do not like each
other.
Soyou are having
problems getting along
with your mother. You
are concerned about
your relationship with
her.
Yes!
123
124
126
Summarising (1)
127
Summarising (2)
Summarising helps the clinician
Example of summarising
We discussed your relationship with
your husband. You said there were
conflicts right from the start related to
the way money was handled, and that
he often felt you gave more
importance to your friends. Yet on the
whole, things went well and you were
quite happy until 3 years ago. Then
the conflicts became more frequent
and more intense, so much so that he
left you twice and talked of divorce,
too. This was also the time when your
drinking was at its peak. Have I
understood the situation properly?
Yes, that
is it!
129
Processing
130
Processing (1)
131
Processing (2)
expectations
Information given by his or her family
Counsellors observations
132
Responding
133
Responding
134
Expressing empathy
135
I see.
I understand.
I am sorry
about your job.
I am so tired,
but I cannot
sleep So I
drink some
wine.
When I wake
upI am
already too late
for work.
Yesterday my
boss fired me
...but I do not
have a
drinking
problem!
136
Probing (1)
137
Probing (2)
138
Example of probing
Work problems
related to drug
use?
Actually I have
had lots of
problems, not
only being late.
139
Interpreting (1)
140
Interpreting (2)
2.
3.
141
Example of interpreting
You say you had difficulty in getting
along with your boss. Once you
mentioned that sometimes you simply
broke the rules for the sake of breaking
them. You also said that you are always
late, even when your husband had
everything ready for the children. In the
past, you said it was because of the
negative behaviour of your boss. This
time you blamed your husband. Is it
possible that your problems at work,
like being late, are related to your
alcohol use?
I always
thought I
could control
it.
142
Silence
143
35 Min.
Rotating Roles
This role-play gives you and your colleagues an
opportunity to practise as clinicians and clients.
Each observer will provide feedback at the end of each roleplay (5 minutes).
144
146
Use repetition
147
Encourage practise
Mastering a new skill requires time and practise.
The learning process often requires making
mistakes and being able to learn from them. It is
critical that clients have the opportunity to try
new approaches.
148
149
Activity 3: Script 1
It will be important for us to talk about and work on new
coping skills in our sessions, but it is even more important
to put these skills into use in your daily life. It is very
important that you give yourself a chance to try new skills
outside our sessions so we can identify and discuss any
problems you might have putting them into practise.
Weve found, too, that people who try to practise these
skills tend to do better in treatment. The practise
exercises Ill be giving you at the end of each session will
help you try out these skills.
150
10 Min.
Script 1
Discuss in groups the teaching strategies employed by the
clinician.
151
152
153
Explore resistance
Praise approximations
155
10 Min.
Script 2
Discuss the teaching strategies employed by the
counsellor in the following example:
I noticed that you did not fully complete your homework, but I am
really impressed with the section that you have completed. This is
greatin this section you wrote that on Monday morning you had
cravings but you did not use. That is terrific! Tell me a little more
about how you coped with this situation. In this other section, you
wrote that you used alcohol. Tell me more about itlets analyse
together the risk factors involved in this situation.
156
157
158
Activity 5: Role-playing
30 Min.
159
?
?
?
Questions?
Comments?
160
161
162
Training objectives
At the end of this workshop you will be able to:
1.
2.
3.
4.
5.
6.
163
Introduction to Family
Support
164
Family support
The family is a powerful source of assistance and
support.
Families and significant others can effectively
participate in the treatment process if the client
consents.
165
166
Working with
Families
167
168
Preoccupation
Making changes in themselves
Bargaining
Controlling
Disorganisation
170
Activity 1:
Identify maladaptive reactions
10 Min.
171
Continued
172
Be responsive to a crisis
Building Positive
Communication
Between the Client
and the Family
174
Communication problems
Admit mistakes
Use I statements
176
177
Admit mistakes
Bob forgot that it was his and Catherines 5th wedding
anniversary. A coworker invited him to bowl a few frames after
work, and he accepted. When he arrived home, he discovered
the table set for two and Catherine in tears. When she
confronted Bob about being so late, he responded defensively.
You know I have trouble remembering these things. You
should have reminded me! How am I supposed to know you
were planning a special dinner? Catherine responded, How
could you forget our anniversary? Bob was feeling guilty at
this point, but not wanting to admit he was wrong, defensively
replied, Listen, Catherine, weve been married for 5 years now.
Whats the big deal? Catherine locked herself in the bedroom.
180
Use I statements
Pam, a senior in high school, was out on a date.
Her curfew was midnight, and she was already
late. When Pam arrived home at 1 a.m., her
mother, Emily, was extremely worried. Emily
greeted Pam at the door saying, Youre late! You
could have picked up a phone and called. Youre
always so inconsiderate! Pam responded angrily,
I am not always inconsiderate! A fight ensued.
.
181
15 Min.
182
Confidentiality
183
Confidentiality
184
Precautions
2.
186
If in doubt
187
Support and
Information for Clients
who have Children
188
189
Child protection
Organisations should have policies and procedures in
place to assist practitioners in responding to
suspicions of child abuse and neglect such as:
190
?
?
?
Questions?
Comments?
191
Post-assessment
10 Min.
192
193