LT Chad Wheeler MSW, LCSW-C Assessing Substance Abuse Through Motivational Interviewing

Objectives Identify substance abuse/dependence in clients and provide a motivational Interview. Apply motivational Interviewing in their daily practice. Integrate motivational interviewing into any existing substance abuse assessments.

Topics Addiction/Substance abuse…. What is it? Motivational Interviewing Withdrawals Treatment

What is Addiction/Substance Abuse? Disease model A behavior that persists even though there is apparent risk or harm to oneself or others (consequences) To an outside observer the individual demonstrates diminished, but retrievable, capacity for self-regulation of the behavior Life for the individual has become unmanageable

Motivational Interviewing Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D. Meeting patient “Where they Are” Ask, listen, inform Express empathy Develop discrepancy Roll with resistance Support self efficacy Ask open ended questions Listen reflectively Affirm & summarize Elicit change talk

Three stage process Pre-contemplation stage Not thinking about change Contemplation stage Thinking about it Action and maintenance stages Ready for action/made change

Adolescents Decision made by an authority figure Readiness to change No Diagnosis Parents concern vs. clients

Substance Abuse A maladaptive pattern of substance use leading to clinically significant impairment or distress Missing obligations Hazardous situations Legal problems Continued use despite consequences

Substance Dependence Tolerance Withdrawal Cannot cut down Larger and larger amounts Continued use despite consequences

Brief Interventions Increasing insight and awareness Motivation toward behavioral change Drawing out rather than imposing ideas Empowering to the individual No judgment No right or wrong Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Meeting patient “Where they Are” Does the client want to stop? Skip the diagnosis Brief interventions Denial, anger and refusal of treatment by the client No challenging, opposing or criticizing “Would you be open/willing to…?”

Express Empathy “This must be very hard” Careful with “I” statements Does not mean agree What makes sense to the client may not make sense to you Come back to this stage when met with Resistance

Develop Discrepancy I’m confused Motivation for change happens when a person recognizes a difference between their present behavior and important personal goals Help client to recognize ambivalence Reflective statements

Develop Discrepancy What NOT to do

Develop Discrepancy

Support Self Efficacy

Affirm & Summarize Encourage and praise seemingly small accomplishments “What I’m hearing you say is…” Longest amount of “clean” time Perfect world scenario No judgment or tone

Elicit Change Talk Increase rapport and commitment to change from clients Not necessary to admit to or acknowledge having substance abuse problems Readiness to change What addiction means to them Open-ended questions Active listening

Resistance

Assessment

Withdrawals Alcohol withdrawal syndrome – barbiturates and clonidine –Can be fatal Barbiturates and Benzodiazepines –reducing in steps of 10% every 2–4 weeks depending on the severity of the dependency and the patient's response to reductions –Can be fatal

Withdrawals Opiates -Fentanyl -Morphine -Vicodin (hydrocodone) -Oxycontin -Oxycodone -Codeine -Methadone Nicotine Benzodiazepines(can be fatal)

Symptoms Dysphoria Depression Anxiety Craving Seizures Hallucinations Tremors Paranoia Fatigue Flu-like symptoms

Symptoms Nausea Sweating Sleep disturbance Vomiting Reduced sensory threshold Headache Palpitations Diarrhea Weakness Agitation

Treatment Patient can only receive treatment if they are ready Pharmacological Interventions Prevention/Education Community reinforcement approach Contingency management strategies Inpatient/Outpatient

Anonymous Programs “God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.”

Questions/Comments