1. Cognitive Behavioral Interventions for Substance Abuse Facilitator Training University of Cincinnati Corrections Institute Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

2. CBI-SA was developed by UCCI in 2010 through a collaborative process. Special recognition is provided to Jennifer Luther, Kelly Pitocco and Lori Brusman-Lovins for their significant contributions. Version 2.0 was introduced in October of 2013. Special recognition is also provide to the pilot sites: River City Correctional Center, MonDay Correctional Institution, Bartholomew County Adult Probation and Centerstone. Acknowledgements Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

3. Curriculum Content, Format and Supporting Research Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

4. Curriculum Organization Introduction and Preparation Material Pretreatment Modules (optional) Modules 1-6 Participant Worksheets Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

5. Mod 1 (5) Motivation & Engagement Mod 2 (4) Cognitive Restructuring Mod 3 (8) Emotion Regulation Mod 4 (11) Social Skills Mod 5 (4) Problem Solving Mod 6 (7) Relapse Prevention Optional: Pre-Treatment Mod (3) Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

6. Group Structure Ideal size: 8-10 (max 16 = 2 facilitators) Group time: 1.25-1.50 hours Modified closed group: entry points with pre-requisites, pages 11-13 Preparation requirement: ~30 minutes Homework: a key to transfer of practice Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

7. Session Format Session background – Facilitator notes Session materials Practice work review Group discussion and activities Practice work assignment Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

8. Who May Deliver CBI-SA? Individuals who have successfully completed CBI-SA training Preference to substance abuse professionals State regulations may prohibit those without certification or licensure Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

9. Who Would Benefit from CBI-SA? Clients who score MODERATE or HIGH need in the substance use domain Admission does not require a substance use disorder diagnosis Those with substance abuse or dependence diagnosis are appropriate Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

10. How is the term “Substance Abuse” used in the Curriculum? Substance abuse leads to impairment in some aspect of functioning Individual may or may not be dependent on substances Current substance use (unless in a controlled environment) Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

11. Is Abstinence Required? Abstinence is not required – programs will use their own policies Safety could warrant banning participants currently under the influence Drug testing is often used to monitor, but positive results are evidence of the need for treatment Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

12. Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning – Emotion Regulation, Social Skills, Problem Solving Relapse Prevention We Poured Elements of Effective Intervention into the Curriculum Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

13. Stages of Change Precontemplation CRISISCRISIS Contemplation Determination Action Maintenance Relapse Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

14. Stages of Change Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

15. Project MATCH CBTMET 12 Step Facilitation http://pubs.niaaa.nih.gov/publications/match.htm Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

16. Research on 12 Step Programs 2 Controlled Studies Mandatory AA with Offenders No Beneficial Outcomes Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

17. Self-Help and Support Network Self-Help compliments and extends treatment effects Examples include 12 Step, SMART Recovery, Women for Sobriety Support is key – type of support can vary (church, family/friends, community groups) Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

18. MI + CBT compared to CBT alone for Cocaine TX Attended more sessions Reported greater desire for abstinence Reported expectation of success Expected greater difficulty in maintaining abstinence No differences on cocaine use McKee, et al., (2007) Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

19. Cognitive-Behavioral Treatment (CBT) Trigger Use THOUGHTS FEELINGS BEHAVIORS Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

20. Cognitive-Behavioral Treatment (CBT) Trigger Refuse THOUGHTS FEELINGS BEHAVIORS Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

21. Reinforcement Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

22. Pavlov Video Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

23. SA is Reinforcing Increases Pleasure Social Situation + Substance Use Pleasure Removes Discomfort Stressful Situation + Substance Use Reduced Unpleasant Feeling Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

24. Charlie Brown and Lucy Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

25. Motivational Incentives http://www.bettertxoutcomes.org/motivationalincentives/PAMI.html Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

26. Marijuana Abstinence Post-Treatment Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

27. Use of Lower Cost Items Petry (2000) has shown lower but still significant benefits from low cost incentives Use of fishbowl, refund of fees, etc. Socio-economic status did not change efficacy of incentives Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

28. Review by Bahr, Masters, and Taylor (2012) CBT TCs and Drug Courts lower drug use and crime more than no treatment control Pharmacological treatments associated with lower frequency of drug use Contingency Management led to less drug use – especially when combined with CBT Improved outcomes with Aftercare Bahr, S., A Masters, and B. Taylor (2012) “What Works in Substance Abuse Treatment Programs for Offenders?” The Prison Journal 20(10): 1-20. Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

29. Effective Programs Focus on high-risk offenders Provide strong inducements to receive treatment Include several types of interventions simultaneously Provide intensive treatment Include an aftercare component Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

30. Next Steps Certification Process Trainees must be present for the ENTIRE 3-days of CBI-SA training to be certified on this curriculum Double check spelling and legibility of your name and email address on the sign in sheet. Certificates will be emailed to you within 30 days of successfully completing this session Copies for group facilitation Upon successful completion of this training, UCCI grants you permission copy the worksheets in your manual for use in group facilitation Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.

31. Questions? CBI-SA Program Director Kelly Pitocco 513.556.0806 Kelly.Pitocco@uc.edu www.uc.edu/corrections Copyright © 2013, University of Cincinnati, Corrections Institute, Ohio. V2.0 All rights reserved.