Terrence D. Walton Treatment: Doing The Right Thing …In The Right Way Terrence D Walton, MSW, ICADC

Terrence D. Walton

Treatment Is … Organized, professional helping A professional relationship Based on theory and protocol Governed by legal, professional and ethical standards

Terrence D. Walton Treatment Must Enhance Motivation – Why change? Insight – What to change? Skills – How to change?

Terrence D. Walton What Works? Treatment outcome research reveals a number of effective treatment approaches or types to consider Family Group Individual

Terrence D. Walton For the BEST OUTCOMES Provide a Puzzle of Evidence Based Approaches Cognitive Behavioral Pharmacological Interventions Motivational Approaches Case Management Continuing Care Community Reinforcement

Terrence D. Walton Gender and Cultural Competence

Terrence D. Walton Family/Community Interventions 1) Structural-Strategic Family Therapy 2) Multi-Systemic Therapy (MST) 3) Systematic Training for Effective Parenting (STEP) 4) Community Reinforcement Approach (CRA)

Terrence D. Walton Group Interventions 1) Multi-Family Therapy Groups 2) Psychoeducational Groups 3) Self Help Groups

Terrence D. Walton Individual Interventions 1) Pharmacotherapy/Acunpuncture 2) Cognitive Behavioral 3) Motivational Enhancement Approaches

Terrence D. Walton Pharmacological Interventions Goals – Provide: – relief from withdrawal symptoms * – prevent drugs from working – reduce craving* – aversive reactions * Acupuncture found effective

Terrence D. Walton Pharmacological Interventions Methadone – Opiate addiction – reduces craving, mediates withdrawal symptoms, Buprenorphine – similar to methadone, may be prescribed by an MD with special training Antabuse – produces adverse reaction with alcohol use Naltrexone – stops opiates from working, changes alcohol action for some – reduction in relapse Baclofen – possible reduction in cocaine cravings

Terrence D. Walton Understanding C-B Approaches Cognitions affect: other cognitions, emotions, and behavior. Cognitions lead to behavioral changes. Cognitions play a major role in the development and maintenance of addiction and criminality.

Terrence D. Walton Understanding C-B Approaches Behavior is developed and maintained by external events (cues or reinforcement ) and by internal processes (cognitions) De-emphasizes early child hood experiences and emphasizes the here and now Social learning (How a person came to think as he or she does)

Terrence D. Walton Three C-B Approaches Cognitive Restructuring Models (e.g. criminal thinking models) Coping Skills Models (e.g. stress management models) Problem Solving Models

Terrence D. Walton Reality Therapy: WDEP System W________________ D________________ E________________ P________________

Terrence D. Walton Direction/Doing W________________ A________________ Y________________ D________________

Terrence D. Walton Motivational Approaches How People Change

Terrence D. Walton Why people change W_______ A_______ R________

Terrence D. Walton How People Change 1. Pre-contemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance

Terrence D. Walton Not at all ready to change Thinking about change Preparing to change Actively working on or maintaining a change PreContem- plation Contem- plation Prepar- ation Action Maintenance The “Readiness Ruler"

Terrence D. Walton PRE-CONTEMPLATION

Why people don’t change Reveling Reluctance Rebellion Rationalizing Resignation

Terrence D. Walton CONTEMPLATION

The Decisional Balance 1. What do you want that you… 2. What do you want that you… 3. What are you getting that you…

Terrence D. Walton PREPARATION

ACTION

MAINTENANCE

Traps to Avoid Question – Answer – (“the interrogation”) Taking Sides (arguing for change) Expert Trap Labeling Trap Premature Focus Blaming Trap

Terrence D. Walton GENERAL PRINCIPLES 1. Express Empathy 2. Develop Discrepancy 3. Roll with Resistance 4. Support Self-Efficacy

Terrence D. Walton Express Empathy Acceptance facilitates change Skillful reflective listening is fundamental Ambivalence is normal

Terrence D. Walton Develop Discrepancy The client, rather than the officer should present the arguments for change. Change is motivated by a perceived discrepancy between present behavior and important personal goals or values.

Terrence D. Walton Roll with Resistance Avoid arguing for change. Resistance is not directly opposed. New perspectives are invited, but not imposed. The client is the primary resource in finding answers and solutions. Resistance is a signal to respond differently.

Terrence D. Walton Support Self-Efficacy A person’s belief in the possibility of change is an important motivator. The client, not the officer, is responsible for choosing and carrying out change. The officer’s own belief in the person’s ability to change becomes a self- fulfilling prophecy.