Anthony Muller MA, LPC, CAADC

 Director of Clinical and Business Development  Wedgwood Christian Services

Change What Creates It

Response to treatment in the first few sessions is highly predictive of the eventual outcome.

Common Therapeutic Factors

Relationship Expectancy Technique Client Strengths

Relationship Factors

  Motivational Readiness Therapeutic Alliance

Therapeutic Alliance

     Affective Relationship Clients’ Capacity to Work in Counseling Purposefully Therapist’s Empathetic Understanding and Involvement Client-Therapist Agreement in the Goals and Tasks True Change Partnership

“Within the client is a theory of change waiting for discovery, a framework for intervention to be unfolded and accommodated for a successful outcome”.

Hubble, Duncan, Miller, 1999

Hope and Expectancy

 Possibility Focus  Therapist Expectancy

Know Your Role

Stages of Substance Use

Developmental Psychology

 The study of how things change and stay the same over time.

 Macro Theories of Major Struggles, Events, Cognitions and Developments applicable to almost all adolescents.

Adolescence: Biosocial Development

•Puberty Length of time for average adult to become physically dependent on alcohol 7-14 years Length of time for average adolescent to become physically dependent on drugs or alcohol 9-18 months

Adolescence: Cognitive Development

 Adolescent Egocentrism  Characteristic of adolescent thinking that sometimes leads young people to focus on themselves to the exclusion of others and to believe that their thoughts feelings and experiences are unique  Invincibility fable  Adolescents feel they are immune to the laws of mortality and probability (and nature)  Take all kinds of risks

 Personal fable   Adolescents imagine their own lives as mythical or heroic See themselves destined for fame or fortune  Imaginary audience  Adolescents fantasize about how others will react (opinions of onlookers)   Assume everyone else judges appearance(s) Not at ease with social world

Adolescent Decision Making  Adolescence is a time for personal decisions and independent choices with far-reaching consequences  Because adolescents think about possibilities, not practicalities, few adolescents decide important matters rationally  Egocentrism and intuitive thinking makes it hard to analyze and plan ahead

Identity Status    Erikson’s Developmental Stages – Review of Past Stages Adolescent stage struggle is identity versus role confusion Identity achievement = attainment of identity: self understanding in accord with past experiences and future plans  Willing to reconsider values and goals of parents and culture, accepting some, rejecting others.

Adolescent Development

 Cognitive  Problem Solving  Hypothesize  Inspect Data  Identity & Personality  Many Theories  Erickson’s Developmental Theory  Identify vs Confusion

Emotional Intelligence Pt -1

 Emotional Tasks Needed For “Recovery”  Self Manage Stress  Identification of Feelings  Sort Current Feelings  Expressing & Managing Feelings  Delayed Gratification  Impulse Control •Integrated From Daniel Goleman’s Emotional Intelligence

Emotional Intelligence Pt -2

 Most Substance Abusing or Dependent Adolescents are Behind in Emotional Development.

 For Treatment to be Successful we Must Address and Build Skills to Complete the Emotional Tasks

Why Focus On Change

     Heart Attacks Follow Doctors Orders?

40% Diabetes Follow Doctors Orders?

35% Drug and Alcohol Abuse/Dependent Who Make Significant Change?

 35%

Why Stages of Change

     Change Model Trans Theoretical Model Focuses on Internal Motivation Provides a Treatment “Compass” Concept of “Sequencing Treatment”

Pre-Contemplation

Not Ready To Change    No serious consideration of or desire to change.



Description

May see behavior as posing some problems but not as a problem.

Not aware or denying consequences associated with the behavior

Pre-Contemplation

Not Ready To Change 

Reason For Contact - Mindset

   Pressure From Others Proving to others he/she does not have a problem Court or Legal Referral

Contemplation

Thinking About Change  

Description

Serious consideration to modify behavior  Mostly considers behavior to be a problem  Trying to understand problem  Not yet decided to change

Contemplation

Thinking About Change 

Reason For Contact - Mindset

   To Understand Problem or Get Information To Manage Family Problems To Manage Associated Problems

Preparation

Getting Ready To Make A Change  

Description

Has Decided to commit to Change  Willing to make efforts/pay the price  Ready to Take Responsibility For Change in Behavior  Not Yet Fully Implemented Plan to Change

Action

Ready To Make A Change    

Description

Taking Significant Action on Own or with Professional Help to Modify Problem Implement Plan As Long As Active Attempts With Some Success Are Being Made With Some Success

Maintenance

Continuing To Support Behavior Change  

Description

After Some Period of Active Change, the Individual has Demonstrated Some Ability to Cease or Control the problem  For Research Purposes Generally 6 Months

Pre-Contemplation

Not Ready To Change  

Tasks

Consciousness Raising Education and Feedback  Environmental Reevaluation  Reinforcement Management  Social Liberation  

In English

Intervention-provide info and personalized feedback, increase perception of risks and problems, discuss possibility of change .

Contemplation

Thinking About Change   

Tasks

Self-Reevaluation Environmental Reevaluation    Consciousness Raising Helping Relationship Dramatic Relief  

In English

Intervention - tip balance in favor of change, elicit reasons for change and risks of not changing, increase confidence

Preparation

Getting Ready To Make A Change      

Tasks

Self Liberation Self Reevaluation Helping Relationship Social Liberation  Environmental Reevaluation Dramatic Relief  

In English

Intervention Strengthen commitment, find a change strategy that is acceptable, accessible and effective

Action

Ready To Make A Change      

Tasks

Counter-Conditioning Stimulus Control Helping Relationships Self Liberation Reinforcement Management  

In English

Intervention - Affirm commitment, identify steps, identify resources, check adequacy of plan, skills and preparation

Maintenance

Continuing To Support Behavior Change    

Tasks

Counter-Conditioning Stimulus Control Reinforcement Management  Self-Liberation  

In English

Intervention - affirm commitment, focus on positive benefits noticed, identifying tempting situations, develop relapse prevention plans

Self Help - 12 Step Approach

    Most Utilized Approach In AOD Treatment.

Oldest Of All Major Treatment Approaches Focus of Support and Self Reflection With Recent Professionalism Of Field Many See As A Valuable Support But Not As “A” Or “The” Only Primary Approach To Treatment.

Self Help - 12 Step Approach For Adolescent Treatment

 PRO’S     Easy Model to Follow Broad Reaching Support Focus on Immediate Positive Culture  CON’S     Developmental Challenges Motivation Levels Immediate Strain on Relationship Not Person Centered or Holistic

Disease Concept

    Crux of a Medical Model approach 1956 AMA - “The Disease” Most commonly generalized to all “addictions” Focus - It’s not your fault, It is your responsibility

Disease Concept For Adolescent Treatment

 PRO’S   Medically Endorsed Use Has Serious Effects PPCF  Three - Interrelated Factors  CON’S  If You Are In Treatment You Have The Disease  Genetic Link Only Established For Alcohol  Forever Focus

Developmental Model of Recovery

   Six Stage Objective Process of “Recovery” Comprehensive Linear Model Holistic Life Change Not Just Behavioral Marker of Non-Use   Core Concept Of Process Focus - Progressive Life Style Change Moving From Using Lifestyle To Sobriety

Developmental Model Recovery For Adolescent Treatment

 PRO’S  CON’S     Progressive Objective Markers More Than One Behavior Answers Tough Topic Of Glamorization and Euphoric Recall  Behavioral Markers Where To Go, Not How To Get There  “Dependent” Focus

Nowinski’s Model

    Stages of Substance Use Holistic Assessment - (Functional) Family Assessment Focus - Altogether a complete treatment model. Sees adolescent treatment as different. Thorough assessment, LOC recommendation, strength based treatment plan, holistic treatment12 step oriented.

Functional Assessment

       Education Life Skills

LEISURE COPING

Emotions Self Esteem Spirituality        Cognitive, Literacy, Grade + Future Communication + Assertiveness Meaningful Fun, Peer Group Stress,Anger, Loss, Disappointment Pendulum of Happiness to Anger Self Perception, Future Options Personal Values and Ethics

Nowinski’s Model Adolescent Considerations

 PRO’S  CON’S     Stages of Substance Use Functional Assessment Strengths Based Adolescent Counselor Mindset    Treats All as Addicts LOC Tied With Stages Focus on Denial not Person

Not Just Right Answer Believable to Audience Supportive Context

Medical Marijuana

Alcohol Vs Marijuana Biding One’s Time

Tweeners

SYNTHETIC MARIJUANA

 WHAT IS IT?

  Commonly referred to as K2 or SPICE. It is a dried blend of herbs and spices that is sprayed with a synthetic chemical.  When consumed, K2 or Spice mimics the effects of Marijuana.

SYNTHETIC MARIJUANA

 K2 is sold as incense or potpourri and is commonly purchased in tobacco shops, head shops, gas stations, convenience stores and over the Internet.  It is often marketed as incense or “fake weed.”  It is important for parents to realize that K2 is not illegal in every state so it is easily accessible for purchase over the Internet.

Synthetic marijuana

SYNTHETIC MARIJUANA

        Common street names: Spice Spice Gold Spice Silver Spice Diamond Fire & Ice Demon Genie

SYNTHETIC MARIJUANA

 IT IS OFTEN LABELED AS “POTPOURRII” AND “NOT FOR HUMAN CONSUMPTION”

Synthetic marijuana

 PUBLIC HEALTH OFFICIALS ACROSS THE COUNTRY HAVE NOTED THE INTENSE EFFECTS OF SYNTHETIC MARIJUANA.  SOME HAVE FOUND THAT THE CHEMICALS USED IN THE MANUFACTURING OF SYNTHETIC MARIJUANA CAN CAUSE IT’S EFFECTS TO BE 10 TIMES MORE POTENT THAN MARIJUANA.  IN LARGE DOSES, SYNTHETIC MARIJUANA CAN CAUSE SEVERE HALLUCINATIONS AND DISORIENTATION THAT CAN LAST FOR DAYS.

SYNTHETIC MARIJUANA



WHY IS IT SO POPULAR?

 IT IS SEEN AS A “SAFE” ALTERNATIVE TO MARIJUANA BY TEEN AGERS   IT IS EASY TO BUY IT IS UNTRACEABLE IN DRUG SCREENS WITH IN TWO HOURS OF USE.

Synthetic marijuana

 REPORTED SIDE EFFECTS:  Soaring heart rates  Respiratory issues  Panic attacks  Paranoia,  Hallucinations  Delusions  Vomiting  Increased Agitation

Why Kids Use It

 1. To Avoid Detection  Already have Abuse or Addiction  Already have consequences  2. Alcohol and Marijuana Aren’t Enough  Tolerance has Developed  Tweener Drug  3. Think its Safe and Like Marijuana  Curious  Misinformed

Managing Resistance

 Categories of Resistant Behavior  Arguing  Interrupting  Denying  Ignoring (Miller and Rollnick 1991)

Resistant Behaviors

 Arguing:  Challenging  Discounting  Hostility  Interrupting  Talking Over  Cutting Off (Miller and Rollnick 1991)

Resistant Behaviors

(cont)  Denying  Blaming  Disagreeing  Excusing  Claiming Impunity  Minimizing  Pessimism  Reluctance  Unwillingness to change (Miller and Rollnick 1991)

Resistant Behaviors

(cont)  Ignoring  Inattention  Non-answer  No response  Side tracking (Miller and Rollnick 1991)

Strategies for Dealing with Resistant Behaviors

 Simple Reflection: Respond with “non-resistance” A simple acknowledgement of the client’s disagreement, emotion, or perception. This can permit further exploration rather than defensiveness.

 Amplified Reflection: Reflect back what client has said in an exaggerated or amplified form. Do not use a sarcastic tone.

(Miller and Rollnick 1991)

Strategies for Dealing with Resistant Behaviors,

(cont)  Double Sided reflection:  Acknowledge what the client has said, and add to it the other side of the client’s ambivalence. Example: “You can see some real problems, but you are not willing to think about quitting altogether.

 Shifting Focus:  Shift the client’s attention away from what seems to be a stumbling block in the way of progress.

(Miller and Rollnick 1991)

Strategies for Dealing with Resistant Behaviors,

(cont) 

Agreement with a twist:

 Offer initial agreement, but with a slight twist or change of direction. A reflection followed by a reframe. Example: “You’ve got a good point there, there is a bigger picture, drinking problems like these do involve the whole family.” 

Emphasizing personal choice and control:

 Example: “It really is up to you to decide to change.

No one can make this decision for you. No one can make you change.” Etc. Very important when person feels their freedom has been infringed

Real Talk Topics

Disease Concept Tweeners Broken World Symptom Checklist Dopamine Mj vs Alcohol Stages of Use